Systematic analysis of the burden of ischemic stroke attributable to high LDL-C from 1990 to 2021

Jiahao Tang ¹ Guoyang Zhou ² Shunan Shi ¹ Yuexin Lu ¹ Lin Cheng ² Jianping Xiang ³ Shu Wan ^2* Ming Wang ^2*

• ¹ Zhejiang Chinese Medical University, Hangzhou, China
• ² Brain Center, Zhejiang Hospital, Hangzhou, China, Hangzhou, China
• ³ ArteryFlow Technology Co., Ltd, Hangzhou, Jiangsu Province, China

Background: Low-density lipoprotein cholesterol (LDL-C) is a public health concern linked to ischemic stroke. The study aimed to describe the epidemiological characteristics of ischemic stroke attributable to high LDL-C from 1990 to 2021.In this study, we analyzed data from the Global Burden of Disease 2021 to present trends in ischemic stroke related to high LDL-C over the past 30 years. The relationship between disease burden and the Socio-Demographic Index (SDI) was examined. To assess international health disparities, we applied the Slope Index of Inequality (SII) and the Concentration Index (CI). Furthermore, we conducted a frontier analysis to identify areas for improvement and developmental gaps among nations, and employed the Bayesian Age-Period-Cohort (BAPC) model to forecast the disease burden for the next 15 years.In 2021, the incidence of ischemic stroke attributed to high LDL-C significantly increased compared to 1990, with a more pronounced growth rate in males. The burden mainly affects individuals aged 70 to 84. Analysis using the age-period-cohort model indicates that mortality rates and DALYs rise with age, while period and cohort effects exhibit a gradual decline. Across different SDI regions, trends generally follow a similar downward path, with a narrowing gap in disease burden among regions with varying SDI levels. However, the disease burden in high SDI countries remains significant, indicating potential for reduction. Predictions for the next 15 years suggest that while the global disease burden will decrease, there may be an increase among individuals under 55.Conclusions: Compared to 1990, the overall age-standardized burden of ischemic stroke related to high LDL-C has been controlled. However, disparities persist across different SDI regions. We have observed an increasing burden among younger populations. Consequently, countries and regions must adopt new measures tailored to their SDI 2 levels, with a specific emphasis on younger individuals. It is essential to develop prevention and treatment strategies aimed at high-risk groups.