Trends in Low-Density Lipoprotein Cholesterol Goal Achievement in High Risk United States Adults: Longitudinal Findings from the 1999–2008 National Health and Nutrition Examination Surveys

<div><p>Background</p><p>Previous studies have demonstrated gaps in achievement of low-density lipoprotein-cholesterol (LDL-C) goals among U.S. individuals at high cardiovascular disease risk; however, recent studies in selected populations indicate improvements.</p> <p>Objective</p><p>We sought to define the longitudinal trends in achieving LDL-C goals among high-risk United States adults from 1999–2008.</p> <p><i>Methods</i> We analyzed five sequential population-based cross-sectional National Health and Nutrition Examination Surveys 1999–2008, which included 18,656 participants aged 20–79 years. We calculated rates of LDL-C goal achievement and treatment in the high-risk population.</p> <p>Results</p><p>The prevalence of high-risk individuals increased from 13% to 15.5% (p = 0.046). Achievement of LDL-C <100 mg/dL increased from 24% to 50.4% (p<0.0001) in the high-risk population with similar findings in subgroups with (27% to 64.8% p<0.0001) and without (21.8% to 43.7%, p<0.0001) coronary heart disease (CHD). Achievement of LDL-C <70 mg/dL improved from 2.4% to 17% (p<0.0001) in high-risk individuals and subgroups with (3.4% to 21.4%, p<0.0001) and without (1.7% to 14.9%, p<0.0001) CHD. The proportion with LDL-C ≥130 mg/dL and not on lipid medications decreased from 29.4% to 18% (p = 0.0002), with similar findings among CHD (25% to 11.9% p = 0.0013) and non-CHD (35.8% to 20.8% p<0.0001) subgroups.</p> <p>Conclusion</p><p>The proportions of the U.S. high-risk population achieving LDL-C <100 mg/dL and <70 mg/dL increased over the last decade. With 65% of the CHD subpopulation achieving an LDL-C <100 mg/dL in the most recent survey, U.S. LDL-C goal achievement exceeds previous reports and approximates rates achieved in highly selected patient cohorts.</p> </div

Prevalence of High Risk Conditions in Analyzed Populations NHANES 1999–2008.

<p>(95% CI).</p>*<p>p-value for test for trend over time.</p><p>CHD = coronary heart disease, FRS = Framingham Risk Score.</p

Inclusions/Exclusions.

*<p>Variable only collected in 1999–2000.</p>†<p>MEC Mobile Exam Center.</p>#<p>Peripheral Vascular Disease only collected in 99–00, 01–02, 03–04.</p

Population LDL-C Means and Goal Achievement.

*<p>To convert mg/dL to mmol/L multiply value by 0.0259.</p>†<p>p value compared to the previous survey.</p>‡<p>p value for test for trend over time.</p