Sex-related disparities in hyperlipidaemia and cardiovascular risk in Sri Lanka: a cross-sectional study

Abstract

BACKGROUND: Nearly 80% of the world’s noncommunicable disease (NCD) burden comes from developing countries, where sex-related disparities in healthcare utilisation are common. However, studies on sex-related disparities in lipids and cardiovascular risk among South Asians are limited. This study aimed to investigate sex-related differences in the prevalence, management and outcome of lipids and related cardiovascular diseases (CVDs) among Sri Lankans to inform necessary improvements in preventing, diagnosing, and managing CVDs in females in Sri Lanka, a resource-limited South Asian setting. METHODS: Secondary data from the World Health Organisation’s STEPS survey-2021, a community-based cross-sectional study conducted across Sri Lanka from April to December 2021, were analysed. Hyperlipidaemia was defined as having a total cholesterol (TC) level ≥ 200 mg/dL or being on treatment for hyperlipidaemia. TC goal was defined as a TC level < 200 mg/dL. Rates of hyperlipidaemia prevalence, treatment uptake and TC target achievement were compared between males and females. Sex-related disparities in the associations of hyperlipidaemia and CVDs were assessed separately. RESULTS: The study sample consisted of 4,634 adults (62.8% female) with a mean age of 46 ± 13.7 years. The prevalence of hyperlipidaemia was higher in females (46.3%) than in males (36.4%, P < 0.001). Treatment uptake was not significantly different between females (25.2%) and males (23.6%, P = 0.467). Of those on treatment for hyperlipidaemia, the TC goal achievement was low in females (68.1%) compared to males (82.4%, P < 0.001). Females (4.9%) had a lower prevalence of established CVDs compared to males (10.9%, P < 0.001), but females with hyperlipidaemia had higher odds (OR 1.24, P = 0.038) of CVDs. CONCLUSIONS: Sri Lankan females had a higher prevalence and poorer control of hyperlipidaemia compared to males, despite no significant difference in treatment uptake. However, the presence of CVDs was higher among males and was independently associated with sex and hyperlipidaemia.