The research also provides detailed, country-level insights into the health and economic costs of ASCVD across the US, Canada, UK, Netherlands, France, Germany, Spain, Italy, and Japan.
- After accounting for indirect costs associated with informal caring and lost time and productivity, the total economic burden of ASCVD could be as much as $1.4 trillion globally – or 0.7% of global GDP.
- Up to a third of this burden is attributed to elevated low-density lipoprotein cholesterol (LDL-C, or “bad cholesterol”). Effective management and prevention of LDL-C could avoid as much as $480 billion in direct and indirect costs – roughly the GDP of Vietnam.
- The report also details the health and economic burden of ASCVD and LDL-C in nine countries. Uncontrolled LDL-C accounted for approximately one-third of the burden – much of which could be avoided through better management of LDL-C.
The Office of Health Economics (OHE) has published new research, commissioned and funded by MSD, finding that atherosclerotic cardiovascular disease (ASCVD) is responsible for approximately $680 billion in direct healthcare costs around the world each year, roughly equivalent to the GDP of Sweden.
ASCVD, a condition characterised by plaque build-up in the arteries, is the leading cause of cardiovascular illness and death. Its global prevalence has more than doubled between 1990 and 2021. This growing burden is not limited to older adults: alarmingly, ASCVD is increasingly affecting younger, working-age populations. Between 1990 and 2019, the prevalence of ischemic heart disease – one of the manifestations of ASCVD – increased by more than 20% among individuals aged 20–54; comparatively, those 55 and older saw lower prevalence rates. This highlights an important public-health concern: early-onset ASCVD is rising globally even as overall population trends improve among older adults.
This report is a first in attempting to quantify the global burden of ASCVD, finding that:
- The healthcare costs directly attributable to ASCVD are approximately $680 billion, but when indirect socioeconomic costs like the value of people’s time spent on informal caregiving or taken away from activities such as working or leisure, are accounted for, the total economic impact could double, to as much as $1.4 trillion or 0.7% of global GDP.
- ASCVD is responsible for 261 million disability-adjusted life years (DALYs) around the world each year. DALYs are a measure of health that combine the population-level impacts of mortality and poor quality of life into a single metric.
- Elevated LDL-C (“bad cholesterol”) is responsible for roughly a third of all cases of ASCVD globally, or $230 billion in direct healthcare costs. Much of this is preventable.
The research also provides detailed, country-level insights into the health and economic costs of ASCVD across nine more-developed countries – the US, Canada, UK, Netherlands, France, Germany, Spain, Italy, and Japan.
- The researchers found that total costs associated with ASCVD range from $7.5 billion in the Netherlands to $434 billion in the US.
- In these countries, all of which are developed nations, indirect costs of ASCVD like productivity losses, absenteeism due to illness, and informal caregiving costs outweigh direct healthcare costs, underscoring the impact of ASCVD beyond the healthcare sector.
Chris Skedgel, a Director at the Office of Health Economics and co-author of the report said,
“The research shows the enormous burden of ASCVD – not just to the healthcare system but to the wider economy. What this also tells us is that prevention may have significant pay-offs.
“We found that the greatest overall burden comes from the large share of the population with only moderately elevated LDL-C, rather than the much smaller share with extremely high LDL-C. This finding is slightly counterintuitive and represents one of the paradoxes of prevention: the greatest benefits of prevention often come from prioritising large moderate risk populations rather than relatively smaller populations with the greatest risks.
“In the context of ASCVD, this suggests early detection and management of moderately-elevated LDL-C may deliver the greatest health and economic gains. Investing in prevention means millions of lives lived longer and in better health, and potentially billions saved to the global economy.”
Methodology
This report quantifies the total health and economic burdens of ASCVD, and subsequently the share of these burdens attributable to elevated LDL-C, in terms of disability-adjusted life years (DALYs) as well as direct and indirect costs to health systems, unpaid caregivers, and national economies.
To develop a first indicative estimate of the global burden of ASCVD, the report combines data from the WHO Global Health Expenditure Database (GHED), the 2023 Global Burden of Disease (GBD) Study, and an academic paper estimating NCD expenditure in OECD countries (Institute for Health Metrics and Evaluation (IHME), 2024; WHO, 2023; Grimshaw, Bourke and Blakely, 2025).
The nine core countries studied had the most robust data to use for calculating the ASCVD costs within their territories. In the absence of similar data on the specific proportions of healthcare expenditure directed to ASCVD in other countries, especially low or middle-income countries, the researchers took a four-step approach to estimating this sum for other countries, relying on country-specific data on disease burden on health expenditure.
First, they estimated the current health expenditure by multiplying country-specific estimates of per-capita health spending by population size to estimate total direct healthcare spending by country, adjusted for differences in purchasing power.
To approximate the share of this per-capita expenditure directed towards ASCVD, the authors first assumed that this share of total healthcare spending would be roughly the same as the share of total DALYs associated with ASCVD and its sub-diseases (IHD, IS, and PAD). Second, they adjusted this approximation by the relationship between spending and DALY burden for all non-communicable diseases, to account for the fact we know that the share of spending across all non-communicable diseases isn’t exactly the same as their share of total DALYs.
By doing this, the researchers assumed the ratio of expenditure to burden for ASCVD is roughly the same as for all other noncommunicable diseases (NCDs), like diabetes, cancers, and respiratory diseases. They note that each of these conditions is likely to have their own relationship between burden and expenditure, but in the absence of ASCVD-specific estimates of this relationship, the researchers believe the average relationship between burden and expenditure across all NCDs provides a representative, unbiased estimate in this context.
Finally, the report applies this adjusted ASCVD share to total healthcare spending to estimate how much each country spends on treating ASCVD.
Notes to Editors
This contract research report was commissioned and funded by MSD. MSD was consulted throughout the development of this report and provided opportunity to comment and input prior to submission.
The full report is available online at: https://www.ohe.org/publications/the-burden-of-ldl-cholesterol-driven-atherosclerotic-cardiovascular-diseases/
Contact
For further details, including high-resolution photos, or to arrange a briefing or interview please contact:
Lishani Ramanayake
Media and PR Officer
Office of Health Economics
About the Office of Health Economics
With over 60 years of expertise, the Office of Health Economics (OHE) is the world’s oldest independent health economics research organisation. Every day we work to improve health care through pioneering and innovative research, analysis, and education.
As a global thought leader and publisher in the economics of health, health care, and life sciences, we partner with Universities, Government, health systems and the pharmaceutical industry to research and respond to global health challenges.
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