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0 reviewsAbstractBackground: Previous studies have quantified the burden attributable to high low-density lipoprotein cholesterol (LDL-C) globally or in high-income countries. However, the disease burden of high LDL-C in China has not been fully elucidated. Objective: To systematically evaluate the disease burden attributable to high LDL-C in China from 2010 to 2020, with projections to 2030.Methods: In this population-based study, data were obtained from 644,189 adults across three large-scale, nationally and provincially representative surveys. A comparative risk assessment approach was used to quantify deaths and years of life lost (YLLs) attributable to high LDL-C in China from 2010 to 2020, stratified by age, sex, and region. The drivers of changes in attributable deaths were assessed by decomposition analysis. Furthermore, a proportional change model was used to estimate projections to 2030 under five LDL-C control scenarios: natural scenario, halted the increase, 10% reduction, 20% reduction, and statin treatment improvement.Results: In 2020, the nationally age-standardised LDL-C level among adults aged ≥ 25 years was 112.33mg/dL (95% uncertainty intervals (UIs) 99.97–124.68), equivalent to 2.91 mmol/L (95%UI 2.59–3.23). We estimated that the number of deaths and YLLs attributable to high LDL-C were 813.53 thousand (95%UI 774.81–860.30) and 16,108.31 thousand (95%UI 15,612.47–16,685.53) in 2020. Between 2010 and 2020, the age-standardised mortality rate attributable to high LDL-C increased by 34.41%, while number of deaths increased by 94.02%. This dramatic increase was closely associated with rising LDL-C levels, population growth, and population ageing during the last 10 years. If current trends in LDL-C levels continue, the attributable mortality rate is projected to increase from 79.97 per 100,000 people (95%UI 76.16-84.57) in 2020 to 155.52 per 100,000 people (95%UI 141.73-174.65) by 2030. Only a reduction o