Trends in Lipids and Lipoproteins in US Adults, 1988-2010

Margaret D. Carroll, MSPH; Brian K. Kit, MD, MPH; David A. Lacher, MD, MED; Susan T. Shero, RN, MS; Michael E. Mussolino, PhD

JAMA. 2012;308(15):1545-1554

.ABSTRACT

Context  Serum total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) contribute to atherosclerosis and its clinical consequences. Between the periods 1988-1994 and 1999-2002, mean TC and mean LDL-C declined in adults. During this time, there was an increase in the percentage of adults receiving lipid-lowering medications. Geometric mean triglyceride levels increased but mean high-density lipoprotein cholesterol (HDL-C) remained unchanged.

Objective  To examine trends in serum lipids in adults between 1988 and 2010.

Design, Setting, and Participants  Three distinct US cross-sectional National Health and Nutrition Examination Surveys, 1988-1994 (n = 16 573), 1999-2002 (n = 9471), and 2007-2010 (n = 11 766).

Main Outcome Measures  Mean TC, LDL-C, HDL-C, non–HDL-C, and geometric mean triglyceride levels and the prevalence of lipid-lowering medication use.

Results  Mean TC declined from 206 (95% CI, 205-207) mg/dL in 1988-1994 to 196 (95% CI, 195-198) mg/dL in 2007-2010 (P <.001 for linear trend); mean LDL-C declined from 129 (95% CI, 127-130) mg/dL to 116 (95% CI, 114-117) mg/dL (P <.001 for linear trend). Mean non–HDL-C declined from 155 (95% CI, 153-157) mg/dL in 1988-1994 to 144 (95% CI, 143-145) mg/dL in 2007-2010 (P <.001 for linear trend). Mean HDL-C increased from 50.7 (95% CI, 50.0-51.0) mg/dL during 1988-1994 to 52.5 (95% CI, 51.8-53.2) mg/dL in 2007-2010 (P =.001 for linear trend). Geometric mean serum triglyceride levels increased from 118 (95% CI, 114-121) mg/dL in 1988-1994 to 123 (95% CI, 119-127) mg/dL in 1999-2002 and decreased to 110 (95% CI, 107-113) mg/dL in 2007-2010 (P <.001 for quadratic trend). The prevalence of lipid-lowering medication use increased from 3.4% (95% CI, 2.9%-3.9%) in 1988-1994 to 15.5% (95% CI, 14.7%-16.3%) in 2007-2010 (P <.001 for linear trend). Among adults not receiving lipid-lowering medications, trends in lipids were similar to those reported for adults overall. Among obese adults, mean TC, non–HDL-C, LDL-C, and geometric mean triglycerides declined between 1988 and 2010.

Conclusion  Between 1988 and 2010, favorable trends in lipid levels have occurred among adults in the United States.