Saddique, Muhammad Nabeel

Importance Elevated low-density lipoprotein cholesterol (LDL-C) is a modifiable risk factor for cardiovascular disease, the leading cause of premature death worldwide. Assessing the LDL-C–related burden is critical for guiding prevention and treatment strategies. Objectives To estimate the global, regional, and national burden of ischemic heart disease and ischemic stroke attributable to elevated LDL-C (relative to 35-54 mg/dL) from 1990 to 2023 and to quantify the contributions of population growth, aging, risk-deleted burden, and exposure changes to burden trends. Design, Setting, and Population This comparative risk assessment, part of the Global Burden of Disease Study 2023, estimated population-level LDL-C exposure and associated health loss in 204 countries and territories. Mean LDL-C levels were estimated using spatiotemporal gaussian process regression based on 806 studies across 161 countries. Relative risks were derived from meta-analyses of 38 randomized clinical trials. Population-attributable fractions for deaths and disability-adjusted life-years (DALYs) were estimated by age and sex for adults aged 25 years or older from 1990 to 2023, with 95% uncertainty intervals. Exposure Population-level LDL-C concentrations. Main Outcomes and Measures Population-attributable fractions, counts, and rates (all ages and age standardized per 100 000) of LDL-C–attributable deaths and DALYs from ischemic heart disease and ischemic stroke, with uncertainty intervals. Results In 2023, elevated LDL-C accounted for 3.6 million deaths (95% uncertainty interval, 2.2-5.4 million; 6.0% of global mortality) and 90.7 million DALYs (95% uncertainty interval, 58.9-123.3 million; 3.2% of DALYs). Although global all-ages rates remained stable, age-standardized death and DALY rates decreased by 45.6% and 39.5%, respectively, since 1990. In 2023, age-standardized LDL-C–attributable DALY rates were highest in Eastern Europe and lowest in high-income Asia-Pacific. One-third of the global LDL-C burden occurred in India and China. Population growth and aging drove the increasing burden, with notable regional disparities in LDL-C exposure and risk-deleted DALY rates shifting toward middle-sociodemographic settings. Conclusions and Relevance Despite declining age-standardized rates, the absolute LDL-C burden has increased since 1990 due to demographic changes and has shifted toward middle-sociodemographic countries. Measurement and surveillance gaps persist. Strengthened prevention, diagnosis, and treatment access strategies are essential to mitigate the health burden of LDL-C.

Abstract Background Onco-hypertension, the interplay between cancer and hypertension, is an emerging specialty highlighting the bidirectional relationship between carcinogenesis, anticancer therapies, and blood pressure regulation. In Pakistan, data on physicians’ awareness and management of onco-hypertension are limited, yet critical given the rising global burden of cancer (24.5 million new cases; 9.6 million deaths in 2017) and hypertension (7.6 million annual deaths) worldwide. Methods A cross-sectional survey was conducted from May to October 2023 among physicians in oncology, internal medicine, cardiology, and allied specialties across tertiary hospitals, private clinics, and teaching institutions in Pakistan. A self-structured questionnaire, covering sociodemographic, knowledge, attitudes, and clinical practices, was distributed online and in person. Descriptive statistics summarized respondent characteristics, and inferential tests (t-tests, ANOVA) examined associations (p < 0.05). Results Mean respondent age was 37.5 ± 7.8 years; 58% male. Specialty distribution: internal medicine (45%), oncology (16%), cardiology (17%), nephrology (8%), pulmonology (13%), and others (1%). Nearly half (49%) rated their onco-hypertension knowledge as “average,” and 62% reported challenges managing hypertensive cancer patients. Key perceived causes in previously normotensive patients were anxiety (48%) and corticosteroid use (40%). Sixty-three percent sometimes adjusted antihypertensive regimens based on cancer therapies, and 80% endorsed the necessity of interdisciplinary coordination for optimal management. Conclusion Pakistani physicians demonstrate moderate understanding of onco-hypertension with prevalent management challenges. Findings underscore the need for targeted educational initiatives, validated clinical guidelines, and structured interdisciplinary collaboration to improve cardiovascular outcomes in cancer care.