Although Americans are making some progress in the fight against high cholesterol, there are still many unmet information gaps in the field, particularly in underprivileged areas.
High cholesterol is still a common problem in the US and is a primary cause of cardiovascular disease (CVD). However, recent studies show that adult cholesterol levels are rising.
Furthermore, more adults are becoming aware of high cholesterol and seeking treatment for it, suggesting that public health messaging about the condition is effective. But other communities—Hispanic, Black, uneducated, and low-income people, in particular—remain behind the times.
The goal of the research letterTrusted Source, which was published in the medical journal JAMA Cardiology on November 1st, was to examine the connection between high cholesterol, medication, and awareness. In other words, how many persons who have high cholesterol are genuinely aware that they do? Do they seek treatment if they are aware?
These are crucial considerations since elevated cholesterol is a “silent” risk factor for later-stage, more severe CVD. There are no recognisable symptoms.Reliable Source: Unless your cholesterol is measured, you won’t be aware that you have it.
20+ years’ worth of data
The National Health and Nutrition Examination Survey (NHANES), a programme created to evaluate Americans’ overall health, was used by researchers to extract participant data spanning over 20 years, from 1999 to 2020. Ten of the two-year survey cycles used by the NHANES are covered within this time period. 23,667 individuals who were 20 years of age or older at the time of enrollment were included in the study.
669 (about 3% of the cohort) had “very high” LDL cholesterol (190 mg/dl or more), while 1,851 (about 8%) had clinically “high” LDL cholesterol (160-189 mg/dl). Researchers also categorised people based on how well-informed they were about their conditions. If someone had never had their LDL cholesterol measured or had never been told they had high cholesterol, they were deemed to be “unaware.” People were labelled as “untreated” if they had never been prescribed a statin, or any medicine for high cholesterol.
The percentage of those in the high range who were uninformed and untreated dropped from 52.1% to 42.7%. From 40.8% to 26.8%, those in the extremely high range also decreased.
Despite being in the right direction, the trend is misleading because the numbers are still too large.
Dr. Salim Virani, PhD, a co-author of the letter and adjunct faculty at the Texas Heart Institute and Baylor College of Medicine in addition to vice provost and professor at The Aga Khan University in Pakistan, stated to Healthline, “Our findings show that awareness and treatment of very high levels of LDL cholesterol (bad cholesterol) remain very low in the United States.”
Reduced incidence of excessively high cholesterol
The research letter indicates both good and negative news, so let’s start with the positive.
The good news is that this study has shown a gradual drop in the prevalence of highly increased cholesterol, particularly LDL cholesterol, which is known to be a causative factor in heart disease. And I think that’s because of a lot of things, like just more knowledge,” Stanford University Associate Professor of Medicine Dr. Fatima Rodriguez told Healthline. Rodriguez has no connection to the study.
After adjusting for age, the prevalence of clinically “high” cholesterol fell from 12.4% in 1999—roughly 21.5 million adults—to 6.1% in 2020—roughly 14 million people.
In addition, the proportion of the population with “very high” cholesterol decreased from 3.8% (6.6 million) in 1999 to 2.1% (4.8 million) in 2020.
What is meant by that?
Adults in the US have high LDL cholesterol in 1 in 17 cases, and very high LDL cholesterol in 1 in 48 cases. Over forty percent of people with high cholesterol don’t aware they have it and don’t take medication for it.
Furthermore, approximately 25% of individuals with extremely high cholesterol do not know they have the problem and are not receiving therapy for it.
According to Rodriguez, those numbers are “alarmingly high.”
According to her statement to Healthline, “this work highlights the need of screening people for high cholesterol before problems arise and educating them about the importance of this risk factor and the very effective treatment options available for it, including cholesterol-lowering medications.”
And that’s not all the bad news either.
The letter also shows that there are significant differences in cholesterol levels and knowledge between low-income persons and members of specific ethnic groups. Compared to white people, black and Hispanic persons are more likely to have elevated LDL cholesterol levels. High cholesterol is also associated with low income, not completing high school, and not having health insurance.
Dr. Eduardo SanchezTrusted Source, Chief Medical Officer for Prevention at the American Heart Association, stated, “We’re still way off target.” Sanchez has nothing to do with the study.
Similar findings have been verified and corroborated by AHA research, according to Sanchez.
There is a knowledge gap that needs to be filled and ought to be done so. Not all of those gaps are supported equally. He stated that there is a difference in race and ethnicity as well as a difference linked to poor household income and low educational attainment.
cholesterol, race, and socioeconomic status
In a 2018 edition of CirculationTrusted Source, the relationship between socioeconomic status and cardiovascular outcomes was thoroughly studied.
“A cardiovascular risk that is comparable to traditional risk factors may be conferred by low socioeconomic status, which has been linked to the development of CVD,” the scientists concluded.
To get to that conclusion, they examined four distinct socioeconomic domains: employment, income, education level, and environmental factors. Each of them is accountable for a significant rise in the danger of CVD. Furthermore, it was discovered that people from lower socioeconomic backgrounds do worse when they are sick.
Ethnicity is a risk factor that has to be taken into account when creating cholesterol guidelines, according to a 2019 study by the American Heart Association and more than 10 other health organisations. Virani was on the group that published the guidelines.
“Our organisation is dedicated to reducing the disparity in treatment and awareness of elevated low-density lipoproteins, and we still have work to do in that regard,” stated Sanchez.
However, benefits from higher cholesterol screening and higher use of cholesterol-lowering drugs are also supported by other studies.
Using NHANES data from 1999 to 2018, a study published in the Journal of the American Heart AssociationTrusted Source in 20213 examined these changes in over 50,000 US individuals once again. From that data, researchers were able to identify four encouraging tendencies. During the previous 20 years:
- Screening for cholesterol has increased.
- The mean total cholesterol has decreased.
- The number of persons taking cholesterol drugs is rising.
- Additionally, average LDL cholesterol levels have dropped.
CVD and LDL Cholesterol
In the US, CVD continues to be the leading cause of death. Regretfully, it is rarely possible to link a single risk factor to CVD. Its development is influenced by a number of factors, including genetics, smoking, high blood pressure, nutrition, and family history. High cholesterol is one of the numerous risk factors for CVD that is well-known.
Individuals who have high cholesterol, defined as having total blood cholesterol levels above 200 mg/dl or LDL cholesterol levels above 160 mg/dl, are more likely to develop CVDTrusted Source.
Since high-density lipoprotein (HDL) cholesterol removes cholesterol from the bloodstream and returns it to the liver, it is sometimes referred to as “good” cholesterol as opposed to low-density lipoprotein (LDL) cholesterolTrusted Source.
Rodriguez stated, “In terms of risk, it’s all about the LDL.” According to her, LDL cholesterol should be routinely examined and considered a sign of diabetes, much like A1C.
Make sure to get your LDL levels evaluated frequently, particularly if they have been raised at least once. Start this process as early as possible in life. We are aware that cholesterol accumulates over time, much like tobacco use does,” Rodriguez added.
The final word
According to recent studies, over the previous ten years, Americans’ LDL cholesterol levels have generally decreased.
High cholesterol is still common despite this trend, and both individual and systemic improvements in healthcare are required.
Many people who have high or extremely high cholesterol don’t know they have it and choose not to get treatment.
Cardiovascular health is influenced by socioeconomic variables, and persons of colour, such as Black and Hispanic individuals, are more prone to experience the negative effects of cardiovascular disease.