Log in to MyACC
Current Trends in Cholesterol Levels in Adults With ASCVD
Study Questions:
What trends are noted in levels of low-density lipoprotein cholesterol (LDL-C) and non-high-density-lipoprotein cholesterol (non-HDL-C) in US adults with atherosclerotic cardiovascular disease (ASCVD) in the 21st century?
Methods:
This study evaluated trends in LDL-C and non-HDL-C levels from 1999 through 2016. Records from 4,920 adults with ASCVD from the biannual National Health and Nutrition Examination Survey from 1999 through 2016 were examined. Of these, 4,226 of the records had the information required for analysis. ASCVD was defined as history of heart attack, stroke, angina, or coronary heart disease. Lipid values at the 10th, 25th, 50th, 75th, and 90th percentiles were graphed in a series of box plots over time. Complete LDL-C and triglyceride data were available only through 2014.
Results:
Participants were 58% male with a mean age of 67 years. The proportion of those taking cholesterol medication increased from 37.1% in 1999-2000 to 69.2% in 2015-2016. Mean LDL-C level decreased from 124 ± 37 mg/dl (± standard deviation) to 95 ± 34 mg/dl (-23%; p < .001) between 1999-2000 and 2013-2014. Median (interquartile) LDL-C decreased from 116 mg/dl to 88 mg/dl (-24%; p < .001) during the time interval. Mean non-HDL-C was 158 ± 40 mg/dl in 1999-2000 and decreased to 125 ± 43 mg/dl by 2015-2016 (-21%; p < .001). Median (interquartile) non-HDL-C level decreased from 151 mg/dl to 119 mg/dl (-21%; p < .001) during this time period. Median HDL-C increased from 44 mg/dl to 47 mg/dl (6.8%; p < .001) from 1999 through 2016. Median serum triglyceride levels fell from 147 mg/dl to 106 mg/dl (-28%; p < .001) between 1999 and 2014.
Conclusions:
In this study, mean LDL-C levels decreased by 23% from 1999 to 2014. Non-HDL-C levels dropped by 21% between 1999 and 2016. These decreases are less than half the current recommendation for reducing LDL-C by ≥50% (corresponding to a 45-48% reduction in non-HDL-C) using high-intensity statin or maximally tolerated statin therapy in patients with ASCVD and suggest underutilization of high-dose statin therapy.
Perspective:
The 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines recommends reduction of LDL-C by ≥50% in patients with clinical ASCVD using high-intensity statin or maximally tolerated statin therapy. If this recommendation represents optimal therapy for most patients with ASCVD, then this study suggests a need for increased utilization of high-intensity therapy and statins.
Keywords: Cholesterol, Cholesterol, LDL, Cholesterol, HDL, Lipoproteins, Triglycerides, Nutrition Surveys, Atherosclerosis, Coronary Disease
< Back to Listings
