Abstract: Background　Hypercholesterolemia is an independent risk factor for atherosclerotic cardiovascular diseases，exerting a profound impact on the health of the elderly. However，evidence regarding the disease burden of hypercholesterolemia in the elderly remains limited and requires further elucidation. Objective　To analyze the disease burden and temporal trends of hypercholesterolemia among the elderly globally and in China from 1990 to 2021，thereby providing a reference for optimizing health resource allocation and precisely formulating management strategies. Methods　Data on deaths and disability-adjusted life years（DALYs）of “High LDL cholesterol” in individuals aged ≥ 60 years globally，in China，and across 5 sociodemographic index（SDI）regions were collected from the Global Burden of Disease（GBD）2021 database. Joinpoint regression was used to analyze temporal trends in age-standardized mortality rate（ASMR）and DALYs rate（ASDR）. A three-factor decomposition method was used to quantify the relative impacts of population aging，population growth，and epidemiological changes on the burden. The Bayesian age-period-cohort model was employed to predict the number of deaths and DALYs from 2022 to 2035. Results　In 2021，global and Chinese elderly experienced 2 779 100 and 692 000 hypercholesterolemia-related deaths，increasing 50.34% and 252.34% from 1990，and the DALYs were 50 226 100 and 12 170 100 person-years，rising by 46.62% and 200.96%，respectively. Globally，both ASMR and ASDR for elderly hypercholesterolemia showed a decreasing trend overall（AAPCASMR=-1.65%，95%CI=-1.81% to -1.48%，P<0.001；AAPCASDR=-1.51%，95%CI=-1.67% to -1.36%，P<0.001）from 1990 to 2021，whereas they remained relatively stable in China（P=0.089，0.388）. In 2021，elderly males globally and in China exhibited a higher number of deaths and DALYs，as well as higher ASMR and ASDR，than elderly females. Except for the high-SDI region，the number of deaths and DALYs of hypercholesterolemia in the total elderly population in other SDI regions in 2021 increased to varying degrees compared with 1990. Furthermore，in 2021，the 80-84 years age group accounted for the largest proportion of deaths both globally（463 100 cases，16.66%）and in China（128 300 cases，18.54%）. Population growth was identified as the main driver of increasing disease burden among all regions. The Bayesian age-period-cohort model indicated that the disease burden of hypercholesterolemia among the elderly population will continue to rise globally and in China from 2022 to 2035. By 2035，the number of deaths and DALYs from hypercholesterolemia in the global elderly population are expected to increase by 42.67% and 41.20%，respectively，compared with 2021，while in China they are projected to increase by 82.76% and 72.18%，respectively. Conclusion　The disease burden of hypercholesterolemia among the elderly is substantial both globally and in China，and is expected to grow steadily. To effectively mitigate this escalating burden，it is imperative to enhance public health consciousness，refine the allocation of health resources，and strengthen the research and development of novel lipid-lowering medications.

Key words: Hypercholesterolemia, Older adults, Low-density lipoprotein cholesterol, Epidemiology, Disease burden, Prediction model

摘要： 背景　高胆固醇血症是动脉粥样硬化性心血管疾病的独立危险因素，且对老年人群的健康影响甚大。然而，目前关于老年人群高胆固醇血症疾病负担的研究证据相对不足，亟需补充。目的　分析1990—2021年全球与中国老年人群高胆固醇血症的疾病负担及其变化趋势，为优化卫生资源配置和精准制定防控策略提供参考依据。方法　提取全球疾病负担（GBD）2021数据库中全球、中国及5个社会人口学指数（SDI）地区年龄≥60岁人群“High LDL cholesterol”相关的死亡和伤残调整生命年（DALYs）数据。采用Joinpoint回归分析年龄标化死亡率（ASMR）与年龄标化DALYs（ASDR）率随时间的变化趋势，运用三因素分解分析方法量化人口老龄化、人口增长及流行病学变化对负担改变的相对影响，并借助贝叶斯年龄-时期-队列模型预测2022—2035年死亡人数与DALYs数的变化趋势。结果　2021年全球与中国老年总体人群高胆固醇血症死亡人数分别为277.91万例、69.20万例，较1990年分别增加了50.34%、252.34%；DALYs数分别为5 022.61万人年、1 217.01万人年，较1990年分别增加了46.62%、200.96%。1990—2021年全球老年总体人群高胆固醇血症的ASMR、ASDR整体上均呈下降趋势（AAPCASMR=-1.65%，95%CI=-1.81%~-1.48%，P<0.001；AAPCASDR=-1.51%，95%CI=-1.67%~-1.36%，P<0.001）；与之不同，中国老年总体人群的ASMR、ASDR趋势则相对平稳（P=0.089、0.388），而中国老年男性人群的ASMR整体上呈上升趋势，平均每年上升0.71%（95%CI=0.31%~1.11%，P<0.001）。2021年，全球与中国老年男性人群高胆固醇血症死亡人数、DALYs数、年龄标化死亡率和年龄标化DALYs率均高于相应地区的女性人群。除高SDI地区外，其他SDI地区2021年老年总体人群高胆固醇血症死亡人数和DALYs数较1990年均不同程度地增加。此外，2021年全球（46.31万例，16.66%）与中国（12.83万例，18.54%）老年人群高胆固醇血症死亡人数占比最高的年龄组均为80~84岁组。三因素分解分析显示，人口增长是各地区疾病负担增加的首要影响因素。贝叶斯年龄-时期-队列模型预测结果显示，2022—2035年全球与中国老年人群高胆固醇血症的疾病负担将会持续攀升；2035年全球老年总体人群高胆固醇血症的死亡数和DALYs数较2021年分别将增长42.67%、41.20%，而中国将分别增长82.76%、72.18%。结论　全球与我国老年人群高胆固醇血症的疾病负担沉重，且预计将会持续加剧，因此需通过提高公众健康意识，进一步优化卫生资源配置，并加强新型降脂药物研发力度来遏制不断增加的相关疾病负担。

关键词: 高胆固醇血症, 老年人, 低密度脂蛋白胆固醇, 流行病学, 疾病负担, 预测模型