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. 2026 Feb 1;33(2):204-215.
doi: 10.5551/jat.65834. Epub 2025 Sep 20.

Low-Density-Lipoprotein Cholesterol Control and Treatment Status 1 Year after the Initial Health Checkup in Individuals with Referral-Level LDL Cholesterol

Hiroyuki Aoki  1   2 , Kaori Kitaoka  1   3 , Yuta Suzuki  1   4 , Hidehiro Kaneko  1   5 , Akira Okada  6 , Norifumi Takeda  1 , Hiroyuki Morita  1 , Yukio Hiroi  2 , Koichi Node  7 , Yuji Furui  8 , Tomonori Okamura  9 , Katsuyuki Miura  3 , Hideo Yasunaga  10 , Norihiko Takeda  1
Affiliations

Low-Density-Lipoprotein Cholesterol Control and Treatment Status 1 Year after the Initial Health Checkup in Individuals with Referral-Level LDL Cholesterol

Hiroyuki Aoki et al. J Atheroscler Thromb. .

Abstract

Aims: Despite strong recommendations for medical consultation, the treatment status and low-density lipoprotein cholesterol (LDL-C) levels at 1-year follow-up of individuals with referral-level LDL-C identified in health checkups remain unclear. We evaluated the treatment status and 1-year LDL-C control among individuals identified in health checkups as requiring early medical consultation due to LDL-C levels of ≥ 180 mg/dL.

Methods: We conducted a nationwide cohort study including health checkup data for individuals aged 20-74 years. We identified 102,049 individuals (median age: 48 years; male: 66.8%) with uncontrolled LDL-C (≥ 180 mg/dL) at baseline, who had no prior lipid-lowering therapy. Poisson regression with robust error variance was used to assess factors associated with uncontrolled LDL-C at 1 year.

Results: Among individuals with LDL-C ≥ 180 mg/dL at baseline, 56,147 (55.0%) visited a medical institution within 3 months of the checkup, and 13,124 (12.9%) were prescribed lipid-lowering medications at 1 year. At 1 year follow-up, 49,260 (48.3%) still had LDL-C ≥ 180 mg/dL. Factors associated with persistent LDL-C ≥ 180 mg/dL at 1 year included obesity (RR: 1.07, [95% CI: 1.06-1.09]), 10 mg/dL increase in LDL-C at baseline (1.11 [1.10-1.11]), smoking (1.05 [1.04-1.07]), alcohol consumption (0.95 [0.94-0.97]), poor sleep quality (1.02 [1.01-1.03]), and skipping breakfast ≥ 3 times per week (1.07 [1.05-1.08]).

Conclusions: Despite being classified as requiring early medical intervention, only half of individuals with LDL-C ≥ 180 mg/dL visited a physician within 3 months, and nearly half continued to have uncontrolled LDL-C at 1 year. Strategies to facilitate timely medical visits and appropriate lipid management in health checkup-identified cases are warranted.

Keywords: Cardiovascular risk; Health checkup; Lifestyle factors; Lipid management; Low-density lipoprotein cholesterol.

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Conflict of interest statement

Conflict of interest Research funding and scholarship funds (KF, KN, NT) were received from Fujitsu, Medtronic Japan, Boston Scientific, Simplex Quatum, Japan Lifeline, Murata Foundation, BIOTRONIK JAPAN, UT heart Inc., AstraZeneca, Bayer, Boehringer Ingelheim Japan, Daiichi Sankyo, Eli Lilly Japan, Kowa, Mitsubishi Tanabe, MSD, Novartis, Novo Nordisk, Otsuka, Astellas, Fuji Yakuhin, Mochida, Novartis, Abbott Medical, Daiichi Sankyo Healthcare, Mitsubishi Tanabe, Teijin, Kyowa Kirin Co Ltd, and Bristol Myers Squibb Japan.

Figures

Fig.1. Flowchart
Fig.1. Flowchart
We extracted individuals aged 20–74 years with LDL-C levels ≥ 180 mg/dL at the initial health checkup and with LDL-C data available 1 year later in the JMDC Claims Database. We excluded participants if met the following reasons: (1) those aged < 20 years (n = 9,600), (2) those with LDL-C < 180 mg/dL at the initial health checkup (n = 4,918,519), (3) those with LDL-C data not available 1 year later (n = 66,555), (4) those with prior lipid-lowering medication prescriptions (n = 5,827), (5) those with a history of cardiovascular disease (CVD), dialysis, or kidney transplantation (n = 3,417), (6) those who developed CVD, dialysis, or kidney transplantation between the initial health checkup and 1 year later (n = 1,892), and (7) those with missing data on cigarette smoking (n = 5,436), alcohol consumption (n = 7,960), physical activity (n = 4,116), sleeping quality (n = 1,619), and skipping breakfast ≥ 3 times per week (n = 314). Consequently, the current study included 102,049 participants. CVD; cardiovascular disease
Supplementary Fig.1.
Supplementary Fig.1.
This histogram illustrates the distribution of LDL-C levels at 1 year after the initial health checkup among the 102,049 participants who had baseline LDL-C levels ≥ 180 mg/dL and no prior lipid-lowering therapy. The x-axis represents LDL-C levels in 10 mg/dL increments, and the y-axis shows the frequency (number of individuals) within each range.
See this image and copyright information in PMC

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