Vital Signs: Prevalence, Treatment, and Control of High Levels of Low-Density Lipoprotein Cholesterol — United States, 1999–2002 and 2005–2008

EV Kuklina, MD, PhD; KM Shaw, MS; Y Hong, MD, PhD

Disclosures

Morbidity and Mortality Weekly Report. 2011;60(4):109-114. 

In This Article

Abstract and Introduction

Abstract

Background: High levels of low-density lipoprotein cholesterol (LDL-C), a major risk factor for coronary heart disease (CHD), can be treated effectively.
Methods: CDC analyzed data from 1999–2002 and 2005–2008 to examine the prevalence, treatment, and control of high LDL-C among U.S. adults aged ≥20 years. Values were determined from blood specimens obtained from persons participating in the National Health and Nutrition Examination Survey (NHANES), a nationally representative cross-sectional, stratified, multistage probability sample survey of the U.S. civilian, noninstitutionalized population. The National Cholesterol Education Program Adult Treatment Panel-III guidelines set LDL-C goal levels of <100 mg/dL, <130 mg/dL, and <160 mg/dL for persons with high, intermediate, and low risk for developing CHD during the next 10 years, respectively. A person with high LDL-C was defined as either a person whose LDL-C levels were above the LDL-C goal levels or a person who reported currently taking cholesterol-lowering medication. Control of high LDL-C was defined as having a treated LDL-C value below the goal levels.
Results: Based on data from the 2005–2008 NHANES, an estimated 71 million (33.5%) U.S. adults aged ≥20 years had high LDL-C, but only 34 million (48.1%) were treated and 23 million (33.2%) had their LDL-C controlled. Among persons with uncontrolled LDL-C, 82.8% reported having some form of health insurance. The proportion of adults with high LDL-C who were treated increased from 28.4% to 48.1% between the 1999–2002 and 2005–2008 study periods. Among adults with high LDL-C, the prevalence of LDL-C control increased from 14.6% to 33.2% between the periods. The prevalence of LDL-C control was lowest among persons who reported receiving medical care less than twice in the previous year (11.7%), being uninsured (13.5%), being Mexican American (20.3%), or having income below the poverty level (21.9%).
Conclusions: The prevalence of control of high LDL-C in the United States, although improving, remains low, especially among low-income adults and those with limited access to health care. Strengthening the use of preventive services through improvement in health-care access and quality of care is expected to help achieve better control of high LDL-C in the United States.
Implications for Public Health Practice: To improve LDL-C control levels, a comprehensive approach that involves improved clinical care, as well as improved health-care access, sustainability, and affordability, is needed. A standardized system of patient care incorporating electronic health records, registries, and automated reminders for practitioners, focusing on achieving regular patient follow-up, has the potential to improve control of high LDL-C. Lower out-of-pocket costs and simplification of the drug regimen, as well as involvement of nurses, dietitians, health educators, pharmacists and other allied health-care professionals in direct patient care also could be used to improve patient adherence to prescribed regimens.

Introduction

Having a high level of low-density lipoprotein cholesterol (LDL-C) is a major risk factor for coronary heart disease (CHD), a major cause of death in the United States.[1] Control of high LDL-C can reduce cardiovascular morbidity and mortality substantially,[2] yet high LDL-C remains underdiagnosed and undertreated in the United States. Predictive modeling in one study suggested that every 10% increase in the prevalence of treatment among adults with high LDL-C could prevent approximately 8,000 deaths per year in those aged <80 years.[3] Another study estimated that full adherence to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) primary prevention guidelines* among adults aged 35–85 years could prevent 20,000 myocardial infarctions and 10,000 deaths from CHD and save $2.8 billion in CHD-related health care costs per year.[4] Previous studies demonstrated that many U.S. adults with high LDL-C are not treated adequately.[5] To assess the current status and recent trends in the prevalence, treatment, and control of high LDL-C among U.S. adults aged ≥20 years, data from the 1999–2002 and 2005–2008 National Health and Nutrition Examination Survey (NHANES) were analyzed.

* Additional information is available at http://www.nhlbi.nih.gov/guidelines/cholesterol/index.htm.

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