A few decades ago, Asian diets were regarded as superior because lower incomes meant they ate less meat - and those who were tested had less cholesterol, a substance found in the blood that the body uses to build healthy cells, but which can lead to a build-up in blood vessels. Cholesterol has been correlated to a risk factor for a risk factor for heart attacks.

Whether they are wealthier now or more non-wealthier people are getting tested is unclear, but one thing is; more Asians have higher cholesterol. Cholesterol comes in different types and as time went on guidance changed. Now it is believed that high-density lipoprotein (HDL) 'good' cholesterol should be 1mmol/L or above while only Non-HDL 'bad' cholesterol is considered a risk factor for heart attacks and strokes. 

Cholesterol levels were first linked to saturated fats and then to the trans fats which replaced saturated fats when everyone switched from animal fat to vegetable oil during the cholesterol craze. 

So what happened in Asia? Epidemiologists used data from 102.6 million individuals and examined cholesterol levels in 200 countries across a 39-year time period, from 1980 to 2018, and found that total and non-HDL cholesterol levels have fallen sharply in high income nations, while rising in low- and middle-income nations, particularly in Asia. China, which had some of the lowest levels of non-HDL cholesterol in 1980, had one of the largest rates of increase in non-HDL over the 39 year study period. Countries with similar developments are Malaysia, Philippines and Thailand.  The common denominator; they can all afford more diverse diets. But if you take one risk factor and show change you can always find a benefit or harm. There are not fewer deaths in Europe or the U.S. even though cholesterol dropped.



The authors behind the paper claim that regulatory policies which shift diets from saturated to non-saturated fats will help save millions of deaths from high non-HDL cholesterol in these regions, but that is a very narrow conclusion to draw from an exploratory observational result. Exploratory papers cannot draw conclusions that way because there is no way to know that all of the "attritutable deaths" would not have happened. Peer-review is under fire due to recent scandals in New England Journal of Medicine and The Lancet and it is because sloppy epidemiological claims that can't be replicated slide into publication.

The solution likely is not government panels but for higher incomes to become the norm, and then people will not indulge once their standard of living rises.

If you want to stay off statins, the best bet is to avoid the epidemiological claim of the month and eat a sensible, balanced diet, not count on a government panel to pick your dinner.