Trends in Lipids and Lipoproteins in US Adults, 1988-2010

Study Questions:

Have levels of serum lipids changed over the past several decades among American adults?

Methods:

Data from the National Health and Nutrition Examination Surveys, 1988-1994 (n = 16,573), 1999-2002 (n = 9,471), and 2007-2010 (n = 11,766) were used for this analysis. The primary outcomes of interest were mean total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), non–HDL-C, and geometric mean triglyceride levels. Trends in the prevalence of lipid-lowering medication use were also assessed.

Results:

Mean total cholesterol declined from 206 (95% confidence interval [CI], 205-207) mg/dl in 1988-1994, to 196 (95% CI, 195-198) mg/dl in 2007-2010 (p < 0.001 for linear trend). Declines were also observed in mean LDL-C from 129 (95% CI, 127-130) mg/dl to 116 (95% CI, 114-117) mg/dl (p < 0.001 for linear trend). Mean non–HDL-C declined from 155 (95% CI, 153-157) mg/dl in 1988-1994, to 144 (95% CI, 143-145) mg/dl in 2007-2010 (p < 0.001 for linear trend). Mean HDL-C increased from 50.7 (95% CI, 50.0-51.0) mg/dl during 1988-1994 to 52.5 (95% CI, 51.8-53.2) mg/dl in 2007-2010 (p = 0.001 for linear trend). Geometric mean serum triglyceride levels increased from 118 (95% CI, 114-121) mg/dl in 1988-1994 to 123 (95% CI, 119-127) mg/dl in 1999-2002, and then decreased to 110 (95% CI, 107-113) mg/dl in 2007-2010 (p < 0.001 for quadratic trend). The prevalence of lipid-lowering medication use increased from 3.4% (95% CI, 2.9%-3.9%) in 1988-1994, to 15.5% (95% CI,14.7%-16.3%) in 2007-2010 (p < 0.001 for linear trend). Among adults not receiving lipid-lowering medications, trends in lipids were similar to those reported for adults overall. Among obese adults, mean total cholesterol, non–HDL-C, LDL-C, and geometric mean triglycerides declined between 1988 and 2010.

Conclusions:

The authors concluded that between 1988 and 2010, favorable trends in lipid levels have occurred among adults in the United States.

Perspective:

These trends demonstrate encouraging reductions in serum lipids, including among both men and women, and among adults not taking lipid-lowering therapy. Efforts to understand the factors associated with such trends will help inform future public health policy.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Lipid Metabolism, Nonstatins

Keywords: Cholesterol, Lipids, Lipoproteins, Triglycerides, Nutrition Surveys, United States


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