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18-11-2009 | Cardiometabolic | Article

LDL cholesterol continues to decrease in USA, but still room for improvement


Free abstract

MedWire News: Study results show that the prevalence of high low-density lipoprotein (LDL) cholesterol in the USA has decreased significantly since 1999, but use of lipid lowering medications could still be improved.

Elena Kuklina (Centers for Disease Control and Prevention, Atlanta, Georgia, USA) and colleagues investigated trends in screening prevalence and use of lipid-lowering medications in National Health and Nutrition Examination Survey (NHANES) participants between 1999 and 2006.

In total, 7044 participants from the years 1999–2000 (n=1646), 2001–2002 (n=1930), 2003–2004 (n=1744), and 2005–2006 (n=1724) were included in the analyses.

High LDL cholesterol was defined as a concentration above the specific goal for each risk category, namely, less than 100, 130, and 160 mg/dl (2.59, 3.36, and 4.14 mmol/l) in high-, intermediate-, and low-risk individuals, respectively.

Writing in the Journal of the American Medical Association, the team report that the prevalence of high LDL cholesterol in individuals aged 20 years or older decreased significantly from 31.5% during 1999–2000 to 21.2% during 2005–2006.

When stratified by risk category, the prevalence of high LDL cholesterol during 2005–2006 was 58.9%, 30.2%, and 11.0% in high-, intermediate-, and low-risk category individuals, respectively.

Of note, self-reported use of lipid lowering medications only moderately increased from 8% during 1999–2000 to 13.4% between 2005 and 2006. In addition, screening rates did not change significantly over the time period and remained at less than 70%.

The researchers say that their results indicate that “one-third of participants with high LDL cholesterol levels were unscreened and thus missed an opportunity to improve their LDL cholesterol levels.”

In an accompanying editorial, J Michael and Thomas Gaziano (Harvard University, Boston, Massachusetts, USA) commented: “Abandoning the fixed LDL cholesterol threshold and targets used in many guidelines is justified by the linear relationship of cholesterol lowering and the benefit of the intervention for preventing CVD.”

They suggested: “The use of a simplified risk based approach could increase the ease of implementation of treatment and increase the number of patients receiving beneficial lipid-lowering therapy.”

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2009

By Helen Albert