Explaining Adverse Cholesterol Levels and Distinct Gender Patterns in an Indonesian Population Compared with the U.S

In order to shed light on the biological and social drivers underlying the dramatic rise in cardiovascular disease risk in lower-income settings, links between these risks and body composition, behavioral and socioeconomic factors in Aceh, Indonesia, are contrasted with the United States. We focus on rigorously-validated measures of HDL and non-HDL cholesterol among adults. Indonesians present with adverse cholesterol biomarkers relative to Americans, despite being younger and having lower body mass index. Adjusting for age, these gaps increase in magnitude. Body composition, behaviors, demographic and socioeconomic characteristics that affect cholesterol do not explain between-country HDL differences, but do explain non-HDL differences, after accounting for medication use. On average, gender differences are inconsistent across the two countries and persist after controlling observed characteristics. Leveraging the richness of the Indonesian data to draw comparisons between males and females within the same household, the gender gaps among Indonesians are not explained for HDL cholesterol, but attenuated substantially for non-HDL cholesterol. This finding suggests that unmeasured household resources play an important role in determining non-HDL cholesterol. More generally, they appear to be affected by social and biological forces in complex ways that differ across countries and potentially operate differently for HDL and non-HDL biomarkers