Does my Cholesterol Know Where I Live?

High cholesterol linked to higher country income and lower healthcare spending

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Residents of countries with higher incomes and more efficient healthcare systems tend to have lower cholesterol rates. Less out-of-pocket healthcare spending also contributed to reduced cholesterol rates.

The study primarily examined individuals with a history of high cholesterol, looking at subsequent cholesterol rates.

"Maintain a healthy weight to keep cholesterol at an optimal level."

Elizabeth A. Magnuson lead author of the study and director of the Health Economics and Technology Assessment at Saint Luke’s Mid America Heart Institute, said that investigators found that individuals residing in countries in the highest third of gross national income or healthcare performance and efficiency, as defined by the World Health Organization, had a significantly reduced likelihood of elevated cholesterol as compared to patients in less wealthy countries.

She noted that patients living in the top third of countries in out-of-pocket health expenditures also were more likely to have high cholesterol as compared to those with lower healthcare costs.

During the study investigators reviewed a database of more than 53,000 patients at an increased risk of a heart attack or stroke from 36 countries in North and Latin America, Western and Eastern Europe, the Middle East, Asia, Japan and Australia. Researchers focused on patients with total cholesterol that exceeded 200 mg/dL, and how it could be linked to a country's gross national income, out-of-pocket health expenses and the efficiency of healthcare systems.

Of the patients studied, 38 percent were found to have high cholesterol, ranging from a high of 73 percent in Bulgaria to a low of 24 percent in Finland.

They noticed that cholesterol was significantly higher in Eastern European countries including Bulgaria, Lithuania, Romania, Ukraine, Hungary and Russia. These countries ranked lower economically and in terms of healthcare efficiency.

U.S. residents were found to have similar levels of high cholesterol to other developed nations including Finland, the United Kingdom, Australia, Canada and Israel, though healthcare spending in the U.S. was notably higher.

Among patients with a history of high cholesterol, investigators discovered that total cholesterol increased as a country's income and healthcare system performance declined. A similar association was not found among patients without a history of high cholesterol, though the study did note that patients with a prior history of elevated cholesterol had higher rates than those who were initially diagnosed.

Investigators are planning future studies to examine the reasons behind the associations. Researchers noted that because the study focused on patients with healthcare access, rates of high cholesterol could be underestimated.

“Optimal management of cardiovascular disease is complex, and country-level variation in rates of elevated cholesterol may be due to differences in clinical guidelines, as well as whether and the extent to which guidelines are followed and specific initiatives are effectively implemented,” Magnuson said.

“The association between high cholesterol and out-of-pocket healthcare expenses may reflect an inability or unwillingness for patients in countries with higher out-of-pocket expenses to be compliant with prescribed medications. The recent availability of generic cholesterol-lowering therapy should make out-of-pocket expense less of a barrier.”

The study was recently published in the American Heart Association journal Circulation.

Reviewed by: 
Review Date: 
April 10, 2012
Last Updated:
April 11, 2012