Prevalence of lipid abnormalities in the United States: the National Health and Nutrition Examination Survey 2003-2006

Abstract

Background: The association between increased low-density lipoprotein cholesterol (LDL-C) and increased risk for cardiovascular events is well established, with treatment focusing on LDL-C lowering. Other lipid abnormalities are also associated with increased cardiovascular risk (eg, low high-density lipoprotein cholesterol [HDL-C], high triglycerides [TG], and high non-HDL-C). Despite national lipid guidelines, the prevalence of these abnormal lipid parameters alone or in combination (mixed dyslipidemia) is not well recognized.

Objective: We assessed the prevalence of high LDL-C, low HDL-C, high TG, high non-HDL-C, and mixed dyslipidemia by using National Health and Nutrition Examination Survey (NHANES) data to estimate the proportions of U.S. adults not at guideline-recommended lipid goals.

Methods: NHANES 2003-2006 fasting blood serum data were used to categorize adults aged ≥20 years by LDL-C (risk stratum-specific), HDL-C (men, <40 mg/dL; women, <50 mg/dL), non-HDL-C (in subjects with TG ≥200 mg/dL), and TG (≥150 mg/dL) target levels with use of the NCEP ATP III definitions based on coronary heart disease (CHD) risk.

Results: An estimated 53% (105.3M) of U.S. adults have lipid abnormalities: 27% (53.5M) have high LDL-C, 23% (46.4M) have low HDL-C, and 30% (58.9M) have high TG. Among patients with serum TG levels ≥200 mg/dL, approximately 13% (25.7M) of adults have non-HDL-C levels ≥130 mg/dL. Also, 21% (42.0M) of U.S. adults have mixed dyslipidemia (high LDL-C with either low HDL-C and/or high TG), with nearly 6% (11.6M) having all three lipid abnormalities. For LDL-C, an estimated 23M adults with CHD or a CHD risk equivalent and 17M with ≥2 risk factors but a Framingham risk ≤20% are not at goals of <100 and <130 mg/dL, respectively.

Conclusion: Prevalence of dyslipidemia in the United States continues to be high, with the majority of U.S. adults now affected by some form of lipid abnormality. Efforts to promote screening, risk stratification, and initiating appropriate treatment should be intensified.