Trends in lipids and lipoproteins in US adults, 1988-2010.
Level 4 - case-series / case-control
Serial cross-sectional population surveys
PubMed 23073951 · doi:10.1001/jama.2012.13260
What was done
Data from three cross-sectional cycles of the National Health and Nutrition Examination Survey (NHANES) were analyzed to track trends in lipid levels and medication use among US adults: 1988–1994 (n = 16,573), 1999–2002 (n = 9,471), and 2007–2010 (n = 11,766). Measured outcomes included mean total cholesterol (TC), LDL-C, HDL-C, non-HDL-C, geometric mean triglycerides, and the prevalence of lipid-lowering medication use.
What was found
From 1988–1994 to 2007–2010, mean TC decreased from 206 mg/dL (95% CI, 205–207) to 196 mg/dL (95% CI, 195–198; P < .001), LDL-C decreased from 129 mg/dL (95% CI, 127–130) to 116 mg/dL (95% CI, 114–117; P < .001), and non-HDL-C decreased from 155 mg/dL (95% CI, 153–157) to 144 mg/dL (95% CI, 143–145; P < .001). Mean HDL-C increased from 50.7 mg/dL (95% CI, 50.0–51.0) to 52.5 mg/dL (95% CI, 51.8–53.2; P = .001). Geometric mean triglycerides rose from 118 mg/dL (95% CI, 114–121) in 1988–1994 to 123 mg/dL (95% CI, 119–127) in 1999–2002 before falling to 110 mg/dL (95% CI, 107–113) in 2007–2010 (P < .001 for quadratic trend). Lipid-lowering medication use increased from 3.4% (95% CI, 2.9%–3.9%) to 15.5% (95% CI, 14.7%–16.3%; P < .001). Similar lipid improvements occurred among adults not taking lipid-lowering medications and among obese adults.
Why it matters
This study documents substantial population-wide improvements in cardiovascular lipid profiles over two decades in the US, driven both by increased statin/medication use and concurrent secular trends among untreated individuals.
Limits
The repeated cross-sectional design cannot establish individual-level longitudinal trajectories or prove causal mechanisms for the improvements seen in untreated adults. Changes in dietary intake, physical activity, or unmeasured lifestyle factors across survey waves were not reported in the abstract.
Cited by
- supports The average LDL cholesterol level in the general population is approximately 115 to 120 mg/dL, and average levels in heart attack patients are only slightly higher.