Citations

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.

Breast cancer is one of the most common cancers in females. In low- and middle-income countries like Pakistan, reported incidence and prevalence remain unreliable. The aim was to evaluate Pakistani women’s knowledge, attitude, and perception of breast cancer. This cross-sectional study was conducted among Pakistani women from Punjab, Pakistan. A self-administered online questionnaire was formulated to collect data from the participants from September 24, 2022, to October 24, 2022. The questionnaire included sociodemographic data, knowledge questions regarding breast cancer risk factors, knowledge questions about symptoms of breast cancer, and questions assessing the participants’ attitudes toward mammography screening. For knowledge questions, a score of more than 7 out of 13 was considered good knowledge. For attitude questions, regression analysis was done and a score of more than 5 out of 11 was considered a positive attitude. Data was analyzed using SPSS version 25 (Chicago). 796 women participated in this study. Out of 796 participants, 543 (68.2%) were between 20 and 30 years of age, and 43 (5.4%) were more than 40 years old. The level of knowledge regarding breast cancer risk factors was suboptimal. 523 (65.7%) of the participants thought that breast cancer risk increases with advancing age and 218 (27.4%) thought that early menarche increases the risk of developing breast cancer. 471 (59.2%) mentioned that mammography is an effective tool for detecting breast cancer, and 30 (3.8%) thought that there is a cure for breast cancer. According to regression analysis, higher education, higher monthly household income, and married marital status were significantly associated with good knowledge related to breast cancer. Although most of the population is aware of breast cancer’s risk factors and symptoms, they avoid screening such as mammography. Public awareness projects could help increase women’s knowledge of breast cancer signs, symptoms, and screening.