Trends in ATP-III-Defined High Blood Cholesterol Prevalence, Awareness, Treatment and Control Among U.S. Adults
Introduction
A major modifiable risk factor in the development of atherosclerosis and subsequent coronary heart disease (CHD) is increased levels of low-density lipoprotein (LDL) cholesterol (1). Statin therapy has been shown to lower LDL cholesterol by 30% to 40% and reduce CHD incidence by 23% to 31% 2, 3. The National Cholesterol Education Program's third Adult Treatment Panel (ATP-III), along with an update including results from five major lipid-lowering clinical trials, provide guidelines for the diagnosis and treatment of high blood cholesterol 3, 4.
Previous analyses have identified trends in higher awareness, treatment, and control of total cholesterol. However, the ATP-III guidelines recommend LDL cholesterol as the primary target of clinical lipid management. Therefore, it may be more relevant to characterize trends in high LDL cholesterol for U.S. adults.
The primary aim of the present analysis was to determine trends in the percentage of U.S. adults ages 20 years and older with high LDL cholesterol in 1988−1994 and 1999−2004 using serial National Health and Nutrition Examination Surveys (NHANES) and cut-points derived from the ATP-III guidelines. Additionally, trends in high LDL cholesterol awareness, treatment and control were calculated over this same time period.
Section snippets
Study Population
Data from the current study were derived from NHANES III for 1988 through 1994 and NHANES 1999−2004. These surveys, conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention, are nationally representative samples of the noninstitutionalized civilian U.S. population identified through a stratified, multistage probability sampling design. In each survey, participants were asked to complete in-home interviews followed by a visit to a mobile
Results
Compared with 1988−1994, the age-standardized mean total- and LDL-cholesterol levels were significantly lower in 1999−2004 (Table 1). Additionally, there was a shift in the distribution of US adults into lower ATP-III-defined total- and LDL-cholesterol groupings. In contrast, significant increases in HDL cholesterol and triglyceride levels occurred between 1988−1994 and 1999−2004.
The prevalence of CHD, including risk equivalents, did not significantly change from 1988−1994 (15.5%) to 1999−2004
Discussion
Although the prevalence of high LDL cholesterol in U.S. adults did not change significantly between 1988−1994 and 1999−2004, substantial increases in the awareness, treatment, and control of high LDL cholesterol occurred during this time period. In 1999−2004, more than half of individuals with high LDL cholesterol were aware of this condition, and a majority of those aware were treated with pharmacologic lipid-lowering medication. However, the most impressive observation may be that, between
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