Cholesterol control improves but cardiovascular disease still increases in Mexico

Despite improved statin use and cholesterol control, cardiovascular disease risk rose in Mexico between 2016 and 2023, according to a study being presented at ACC Latin America 2025 that used region-specific tools to more accurately predict the local disease burden.

Cardiovascular disease is the leading cause of death in the world, costing billions each year in care. Factors such as socioeconomics, demographics, hypertension, cholesterol, air pollution, obesity and more can play a role in the types of cardiovascular disease (CVD) burden a country or region may be most impacted by. Most models to predict cardiovascular disease risk use data from high-income countries or from low- and middle-income settings outside Latin America and the Caribbean (LAC), but in this study researchers used two region-specific tools.

Any decision regarding the implementation of risk models, whether based on national or regional recommendations, must rely on the most accurate tools available for the target population. This applies whether the model is used in clinical practice or for public health purposes. This is particularly important for health care professionals and stakeholders, whose decisions about which model to adopt can directly influence key outcomes such as cost-effectiveness, health gains across different cardiovascular conditions, reimbursement policies and the successful implementation of preventive strategies."

César Daniel Paz-Cabrera, MD, specialty in preventive medicine at the Instituto Nacional de Salud Pública in Mexico City and study's lead author

The study analyzed data from the 2016-2023 Mexican National Health and Nutrition Surveys (ENSANUT) to estimate cardiovascular risk in Mexico. Risk factors included systolic blood pressure, total cholesterol, diabetes, smoking, body mass index, sex and age. The researchers estimated risk category prevalence and control of key factors by risk levels.

Researchers used two region-specific tools-Globorisk-LAC and World Health Organization (WHO) models-to estimate cardiovascular disease risk trends in Mexico. According to Paz, both models use similar risk factors to estimate 10-year risk for coronary artery disease and stroke. The key difference is their source populations: Globorisk-LAC relies on data from nine cohorts across six LAC countries to create risk tables for 31 LAC countries, including Mexico, while WHO uses data mainly from high-income regions and provides charts only for subregions within LAC.

Both models found the average 10-year CVD risk increased between 2016 and 2023. The Globorisk-LAC lab-based and office-based models estimated average risks of 9.5% and 9.2%. The WHO model also found CVD risk had increased, it yielded a lower 4.4% increase. WHO models may underestimate CVD risk because population data used to estimate likely include some people already on prevention therapies, Paz said. Additionally, Mexican adults have higher burdens of obesity, diabetes and high cholesterol at younger ages, which are not fully captured by global coefficients. As a result, the WHO model tends to "flatten" local risk gradients, underestimating the true CVD burden, he said.

Statin use among those eligible based on Globorisk-LAC lab-based criteria (age, sex, smoking, systolic blood pressure, total cholesterol, diabetes status) rose from 1% in 2016 to 59% in 2023. According to data from the National Health and Nutrition Survey (ENSANUT) in Mexico, LDL-C control (also known as "bad" cholesterol) improved in low, moderate and high-risk groups, but worsened in the very high-risk group, demonstrating gaps in secondary prevention. By 2023, blood sugar control reached 78.6% and 46.5% for blood pressure control.

"Public health measures such as taxation of sugary drinks, front-of-package warning labels, the elimination of industrially produced trans-fatty acids, and the prohibition of advertising and selling ultra-processed foods and sugary beverages in educational institutions have proven highly effective in Mexico and other countries in LAC," Paz said.

Other potential interventions include the correct implementation of current guidelines and national health care protocols recently approved by the Mexican Ministry of Health, which provide evidence-based recommendations for the prevention, diagnosis and treatment of priority diseases defined by the General Health Council, including hypertension, Type 2 diabetes, metabolic syndrome, obesity and overweight. According to Paz, ensuring efficient mechanisms for the procurement of medicines and medical supplies is essential to avoid delays in screening strategies, preventing treatment abandonment and reducing the risk of future complications.