Nov. 17, 2009 – Looking at the change from 1999 to
2006, it appears the war is being won against LDL cholesterol, the “bad”
cholesterol. The number of adults in the U.S. with a high level of LDL
decreased by about one-third during that period. But a high percentage
of adults still are not being screened or treated for high cholesterol
levels.
Elevated levels of low-density lipoprotein
cholesterol (LDL-C), the major atherogenic lipoprotein, are a primary
focus for cholesterol management of the National Cholesterol Education
Program Adult Treatment Panel III (NCEP ATP III), according to
background information with the study in the November 18 issue of the
Journal of the American Medical Association..
"The guidelines set LDL-C target levels that are
based on the history of coronary heart disease (CHD) or risk for
developing CHD in the next 10 years," the authors write. Few studies
have described the prevalence of high LDL-C levels and the use of
lipid-lowering medications across all CHD risk categories.
Elena V. Kuklina, M.D., Ph.D., of the Centers for
Disease Control and Prevention, Atlanta, and colleagues investigated
trends in the prevalence of screening, current use of
cholesterol-lowering medication, and high LDL-C levels across 4 study
cycles (1999-2000, 2001-2002, 2003-2004, and 2005-2006).
The researchers used data from the National Health
and Nutrition Examination Survey (NHANES), and restricted the study
sample to fasting participants age 20 years or older (n = 8,018),
excluded pregnant women (n = 464) and participants with missing data (n
= 510), with the final study sample consisting of 7,044 participants.
Overall prevalence for high LDL-C levels decreased
from 31.5 percent in 1999-2000 to 21.2 percent in 2005-2006.
"However, this prevalence varied substantially by
risk category. The highest prevalence of high LDL-C levels was observed
in the high-risk ATP III category with 69.4 percent and 58.9 percent
during the first and last cycles, respectively," the authors write.
Participants with a self-reported history of CHD,
angina, heart attack, stroke, and diabetes mellitus or participants with
a fasting blood glucose level of 126 mg/dL or greater were placed in the
high ATP III risk category.
There were no significant changes observed in the
weighted age-standardized screening rates from 1999-2000 to 2005-2006.
Among participants with high LDL-C levels, 35.5 percent were unscreened,
24.9 percent undiagnosed, and 39.6 percent untreated or inadequately
treated in 2005-2006. In the high-risk category, about one-fifth of
participants were eligible for lipid-lowering drug therapy but were not
receiving it in 2005-2006.
"Self-reported use of lipid-lowering medications
increased from 8.0 percent to 13.4 percent, but screening rates did not
change significantly, remaining less than 70 percent during the study
periods," the authors note. They add that the goal of improving
screening rates may be hindered by the lack of consensus regarding the
age at which screening should start
Editorial: Simplifying the Approach to the
Management of Dyslipidemia
In an accompanying editorial, J. Michael Gaziano,
M.D., M.P.H., of the VA Boston Healthcare System and Brigham and Women's
Hospital, Boston, and Contributing Editor, JAMA; and Thomas A. Gaziano,
M.D., M.Sc., of Brigham and Women's Hospital and Harvard School of
Public Health, Boston, write that cholesterol guidelines need to be
simplified.
"Even though there has been progress in identifying
and treating patients with dyslipidemia, the current guidelines are
overly complicated, and a simplified risk-based approach is supported by
the current data. Abandoning the fixed LDL-C threshold and targets used
in many guidelines is justified by the linear relationship of
cholesterol lowering and the benefit of the intervention for preventing
cardiovascular disease. The use of a simplified risk-based approach
could increase the ease of implementation of treatment and increase the
number of patients receiving beneficial lipid-lowering therapy."
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