The prevalence of US adults with high LDL cholesterol levels, and the prevalence of adults who are unaware of their high LDL-C are both declining. However, these improvements aren’t happening nearly fast enough – especially given our expanding cholesterol treatment options.
That’s the takeaway from a new JAMA Cardiology Research Letter analyzing National Health and Nutrition Examination Survey data from 23,667 US adults from the National Health and Nutrition Examination Survey between 1999 and 2020.
Overall, 1851 (7.8%) of the participants had LDL-C levels of 160-189 mg/dL, while 669 (2.8%) had LDL-C levels of 190 mg/dL or greater. Those overall numbers reflect significant age-adjusted declines between the 1999-2000 and 2017-2020 study periods:
- The prevalence of participants with 160-189 mg/dL LDL-C levels fell from 12.4% to 6.1%, representing a decline from 21.5M to 14M US adults
- The prevalence of participants with 190 mg/dL or greater LDL-C levels fell from 3.8% to 2.1%, representing a decline from 6.6M to 4.8 US adults
That period also drove notable declines in Americans who were unaware of their high cholesterol and not receiving treatment.
- The prevalence of unaware/untreated participants with 160-189 mg/dL LDL-C levels fell from 52.1% to 42.7%, representing a decline from 11.9M to 6.1M US adults
- The prevalence of unaware/untreated participants with 190 mg/dL or greater LDL-C levels fell from 40.8% to 26.8%, representing a decline from 3M to 1.4M US adults
At first glance, these cholesterol declines and awareness improvements seem like a public health success story, however the authors were more focused on the 7.5M million Americans with high cholesterol who remain unaware and untreated
These cholesterol awareness and treatment gaps are (unsurprisingly) deepest among Black, Hispanic, and socioeconomically disadvantaged people, as well as among younger people who would benefit most from early treatment.
- These disparities are likely due to challenges with access to primary care, low rates of screening in primary care, lack of consensus on screening recommendations, insufficient emphasis on LDL-C as a quality measure, and hesitance to treat asymptomatic individuals.
Cholesterol awareness and treatment rates might be improving, but they’re still “suboptimal,” and they highlight America’s continued challenges with LDL-C education, screening, and action.