This Insight is based on the WHA79 panel discussion “Lowering Cholesterol, Increasing Impact: The Case for Earlier Action to Address the CV Epidemic”, co-organised by OHE and MSD, at the World Health Assembly in Geneva, May 2026.
OHE research on the burden of LDL-cholesterol-driven atherosclerotic cardiovascular diseases estimated that atherosclerotic cardiovascular disease (ASCVD) could cost the world up to Int$1.4 trillion annually in direct and indirect costs. Elevated LDL cholesterol (or “bad cholesterol”) is responsible for up to one-third of that burden and, crucially, much of this is preventable. A panel convened at the 79th World Health Assembly in Geneva, drawing on this new OHE research, discussed the challenge of how health systems could meaningfully reduce the global burden of elevated LDL cholesterol (LDL-C).
The case for early action
The panel emphasised how ASCVD risk should be understood by health systems. Elevated LDL-C does not cause harm through a single event; instead, it affects individuals living with elevated LDL-C through decades of cumulative arterial exposure, much of which can be largely asymptomatic. By the time an individual living with elevated LDL-C is diagnosed, much of the damage is already done.
This cumulative impact highlights the distinction between reversable and avoidable. As Dr Chris Skedgel, a Director at OHE and senior author of the report, put it: if I go for a bike ride without a helmet, and have an accident that leads to brain damage, those impacts may not be reversible, but all of it was avoidable with appropriate preventative measures. Likewise, intervening after someone has lived for years with elevated LDL-C will not reverse all of the arterial damage, but it could have been avoided with early detection and management.
The implications for health systems is straightforward: given the substantial but avoidable health and economic burdens of ASCVD, there is a clear imperative for better prevention and management of elevated LDL-C.
Where the burden actually sits
OHE’s research also shows that while individual risk of ASCVD rises with LDL-C level, the greatest share of aggregate costs falls in the moderately elevated range (approximately 2.6–4.1 mmol/L), due to the much larger number of individuals living with moderately-elevated LDL-C. That is, a smaller risk in a much larger population can lead to an overall health and economic burden that is much larger than the burdens in the highest-risk population. Dr Michelle Winokur, Executive Director of the International Atherosclerosis Society, emphasised this point, saying “we truly cannot afford to only look at the highest-risk patients.”
Critically, though, this cannot mean neglecting higher-risk groups or people living with very high levels of LDL-C. For example, Magdalena Daccord, CEO of FH Europe, emphasised that familial hypercholesterolaemia (FH), a high-risk inherited condition that causes elevated LDL-C, presents differently: “the FH population is smaller but identifiable through cascade screening. Once we identify one person in a family, we can find everyone else.”
The practical conclusion is that health systems need both a population-level strategy for moderate risk and a targeted approach for inherited conditions, and the infrastructure to deliver them in parallel. The two are mutually reinforcing: broader population screening will inevitably surface undiagnosed FH, making the case for both not a compromise but a compounding benefit.
A system built for the wrong moment
The same structural obstacle came up repeatedly in the panel: most health systems are oriented toward acute care, not prevention.
Patients with borderline-high LDL-C, or those who are well, asymptomatic, or otherwise not yet in need of critical care do not fit naturally into a system designed around clinical urgency.
Dr. Agboyibor, Technical Officer for Cardiovascular Disease at WHO, acknowledged this directly: clinicians typically encounter patients at acute moments, while sustained lipid management across a healthy population requires a different kind of system engagement—one that most countries have not yet built. The WHO’s “Best Buys” programme is currently being updated to include lipid management, signalling an important shift in public health priorities. This underscores that the integration of a 10-year cardiovascular disease (CVD) risk–based approach at each primary health care (PHC) level, through integrated service delivery, is the way forward.
Dr Winokur noted that across the more than 100 countries where IAS has a presence, many still lack a national action plan for lipid management. Her position was unambiguous: “In the absence of an action plan, we should not have inaction.”
The economics reinforce the case for system-level change. A different OHE analysis estimates that an additional year of good health costs around £3,800 through prevention, compared to £13,500 through treatment, yet only around 5.5% of EU healthcare expenditure is currently directed at preventive care.
Detection as a system responsibility
The panel was united that earlier, broader detection is both critical and achievable through better screening, and that the responsibility for early detection lies with health systems, not with individuals.
At a European level, the recently published EU Safe Hearts Plan provides an important policy signal in this direction. Built around three pillars – prevention, early detection and screening, and treatment and care – the Plan represents the European Commission’s recognition of cardiovascular disease as the key health challenge faced by the EU. Notably, it includes the development of an EU protocol on health checks, with a recommendation for regular cardiovascular health checks covering screening for elevated cholesterol, blood pressure and blood sugar. These health checks have been described by the European Atherosclerosis Society as one of the most strategic elements of the Plan and a key enabler of personalised prevention.
The panel highlighted Greece’s national PROLAMVANO programme, an SMS-based invitation for cardiometabolic screening including LDL-C and Lp(a) testing sent to all adults over 30 as a model for proactive, system-initiated detection at scale. Dr Winokur pointed to the value of integrating lipid screening into existing healthcare touchpoints, particularly contacts around pregnancy and menopause for women, rather than relying on patients to self-refer. A clinical encounter is already happening; the question is how well the system uses that encounter.
Dr. Agboyibor noted that context shapes what is feasible. Population-level screening may be realistic in high-income settings; however, in lower-income contexts, active case-finding around established risk clusters – such as people with diabetes or hypertension and their families – may be the more practical entry point. What both approaches share is a common logic: detection cannot depend on patients presenting with symptoms, because by that point the opportunity for early intervention has passed.
The evidence gap for lower-income settings also remains significant.
Dr. Agboyibor’s call to the research community was direct: “We want something we can take to a Ministry of Finance in Mali or across Asia and say, if you invest this amount of money, this is the return you can expect.” Country-specific return-on-investment modelling for low- and middle-income country (LMIC) settings remains one of the most consequential gaps the field could address.
Communication that supports system uptake
Individual awareness of one’s cardiovascular health and risk factors is critical, but the panel was careful to emphasise that this does not mean placing the burden of action on patients. Rather, the system must create and support opportunities for individuals to participate in screening programmes and risk management.
Ms. Daccord argued that the current framing of cholesterol, centred on individual lifestyle and personal responsibility, has largely run its course, and that different communities and age groups require different approaches. Dr Winokur pointed to the practical value of the OHE data in this context: quantitative estimates of CVD burden provide a concrete basis for demonstrating the needs for action in settings like Treasury briefings, parliamentary committees, and international development negotiations, where patient-level clinical data alone may be difficult to contextualise. Lastly, Dr. Agboyibor made the case for ‘shameless advocacy.’ He argued that awareness around the importance of cholesterol management – from the individual, their physician, and the broader healthcare system – is critical and “should no longer be seen as a fancy specialist treatment, rather that everyone knows about cholesterol and has access to the appropriate care.
The case for earlier action
The OHE report demonstrates the substantial but avoidable burdens of ASCVD, providing an impetus for action. Economic evidence and clinical guidelines alone, however, do not translate into action without a meaningful policy and healthcare infrastructure.
The panel pointed to two interrelated priorities. The first is better national cardiovascular health strategies with dedicated, funded plans that recognise LDL-C as a key CVD risk factor, and reframe lipid management as a sustained system priority, with clear targets, defined screening pathways, and accountability for delivery. The EU Safe Hearts Plan sets a framework at European level; the task now is for Member States to follow through with country-level implementation.
The second is improved health literacy, not as a substitute for health system action, but as a complement. People who understand what their cholesterol number means and why it matters while it is still at a healthy level are better placed to take ownership of their cardiovascular health and engage with the screening and management programmes that health systems offer.
Acting on these priorities can lead to a system that can reach people, and people who are have the knowledge and awareness to effectively engage with that system.
The OHE report demonstrates the cost of inaction. What the panel made clear is that action requires political will and strategic system design. Together, these can build an infrastructure for earlier, broader, and more consistent detection and management of elevated LDL-C, preventing the health and economic burdens before they become irreversible.
Based on the WHA79 panel discussion held on 21 May 2026. The underlying research is drawn from the OHE Contract Research Report “The Burden of LDL-Cholesterol-Driven Atherosclerotic Cardiovascular Diseases” (Bray G., Darrow B., Skedgel C., OHE, March 2026), commissioned and funded by MSD.
