Study Finds Cholesterol Levels Have Declined Since 2013 Guideline

Since the implementation of the 2013 ACC/American Heart Association Guideline on the Treatment of Blood Cholesterol, overall cholesterol levels for American adults have improved, especially those on cholesterol-lowering medications, according to a study published Nov. 11 in the Journal of the American College of Cardiology.

Nirav Patel, MD, et al., examined nationwide trends in total cholesterol, triglycerides and LDL-C, as well as high cholesterol awareness and statin usage. A total of 32,278 patients were assessed, and among Americans taking lipid-lowering medication, the age-adjusted total cholesterol declined from 206 mg/dL in 2005-2006 to 191 mg/dL in 2013-2014, with an additional drop to 187 mg/dl in 2015-2016. Average LDL cholesterol among adults taking lipid-lowering medication decreased from 122 mg/dL in 2005-2006.

The number of people being told they had high cholesterol increased from 63.6 percent in 2005-2006 to 69.4 percent in 2011-2012. The percentage remained unchanged through 2015-2016. The proportion of adults eligible for statin use that were actually taking a statin increased from 41.3 percent in 2005-2006 to 49.2 percent in 2015-2016. This percentage was higher among American adults with diabetes, which increased from 48.3 percent in 2005-2006 to 60.2 percent in 2015-2016.

Statin use among the subgroup of patients with a 10-year predicted ASCVD risk of greater than or equal to 7.5 percent remained at approximately 30 percent with a modest decrease of 4 percent in 2015-2016. Researchers said this decrease in statin use could have stemmed from the recommendations in the guideline to have a risk-benefit discussion with shared decision-making when deciding on a statin prescription.

"From a public health perspective, the 2013 guidelines have seemingly improved overall cholesterol levels among American adults on statins," said Pankaj Arora, MD, senior author of the study. "The areas that are unchanged or have decreased since guideline implementation are awareness of high cholesterol and statin use within the highest risk groups. Targeting gaps in clinician guideline education and in patients' perception on statin safety may improve guideline dissemination further."

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Homozygous Familial Hypercholesterolemia, Hypertriglyceridemia, Lipid Metabolism, Nonstatins, Novel Agents, Statins

Keywords: Cholesterol, LDL, Hydroxymethylglutaryl-CoA Reductase Inhibitors, American Heart Association, Triglycerides, Public Health, Hypercholesterolemia, Anticholesteremic Agents, Risk Assessment, Diabetes Mellitus, Decision Making

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