Vital signs: prevalence, treatment, and control of high levels of low-density lipoprotein cholesterol--United States, 1999-2002 and 2005-200

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.