Trends in ATP-III-Defined High Blood Cholesterol Prevalence, Awareness, Treatment and Control Among U.S. Adults

Purpose We sought to determine trends in the prevalence, awareness, treatment and control of high low-density lipoprotein (LDL) cholesterol among U.S. adults. Methods Data from 6497 participants of the Third National Health and Nutrition Examination Survey (NHANES) conducted in 1988−1994 and 5626 participants of NHANES 1999−2004 were compared. High LDL cholesterol was defined using risk-specific cut-points from the National Cholesterol Education Programʹs Adult Treatment Panel III guidelines. Results The age-standardized percentage of U.S. adults with high LDL cholesterol was 26.6% in 1988−1994 and 25.3% in 1999−2004 (P = 0.28). Between 1988−1994 and 1999−2004, awareness increased from 39.2% to 63.0%, and use of pharmacologic lipid-lowering treatment increased from 11.7% to 40.8% (each p < 0.001). LDL cholesterol control increased from 4.0% to 25.1% among those with high LDL cholesterol (p < 0.001). In 1999−2004, rates of LDL cholesterol control were lower among adults ages 20−49 years compared with those age 65 years or older (13.9% vs. 30.3%; p < 0.001); non-Hispanic blacks and Mexican-Americans compared with non-Hispanic whites (17.2% and 16.5% vs. 26.9%, respectively; p = 0.05 and p = 0.008); and males compared with females (22.6% vs. 28.0%; p = 0.01). Conclusions Continued efforts are needed to lower the burden of high LDL cholesterol and increase LDL cholesterol control, especially among populations with low control rates.