NCHStats

Questions for Margaret Carroll, M.S.P.H., Health Statistician and Lead Author on “Total and High-density Lipoprotein Cholesterol in Adults: United States, 2015–2016”

Q: How has the prevalence of high total cholesterol and low levels of high-density lipoprotein (HDL) in U.S. changed since 1999-2000 to 2015-2016?

MC: The prevalence of high total cholesterol (>=240 mg/dL) of adults 20 years and older declined from 1999-2000 to 2015-2016; the prevalence of low high-density lipoprotein(HDL) cholesterol (<40 mg/dL) declined  in adults 20 years and older from 2007-2008 to 2015-2016.  No change was seen from 2013-2014 to 2015-2016 in either high total cholesterol or low HDL cholesterol.

Q: Why is it important to study the prevalence of high total and low HDL cholesterol?

MC: High levels of total cholesterol and low levels of HDL cholesterol are risk factors for cardiovascular disease, the leading cause of death in the United States.

Also, as part of its objectives to improve the health of the U.S. population, Healthy People 2020 has included the goal of reducing the proportion of adults with high total blood cholesterol to less than 13.5%. Both men and women aged 20 and over currently meet this goal. However, not all subgroups meet this target.

Q: Was there anything in the report that surprised you?

MC: The findings did not particularly surprise me.  Based on the earliest available and comparable data from the National Health and Nutrition Examination Survey (NHANES), declining trends were observed in high total cholesterol from 1999–2000 to 2015–2016 and in low HDL cholesterol from 2007–2008 to 2015–2016. However, the observed change for high total and low HDL cholesterol from 2013–2014 to 2015–2016 was not statistically significant.

Q: How does the prevalence of high total and low HDL cholesterol breakdown by age and gender in U.S.?

MC: Men ages 40-59 years have a higher prevalence of high total cholesterol than men ages 20-39 years and 60 years and older but there is no significant difference between men 20-39 years and those 60 years and older.  The prevalence of high total cholesterol is lower in women ages 20-39 years than in women 40-59 years and 60 years and older but there is no significant difference between women 40-59 years and 60 years and older.

Men ages 40-59 years have a higher prevalence of low HDL cholesterol than men 60 years and older.  A declining trend in the prevalence of low HDL cholesterol was seen in women from 20-39 years and 60 years and older.

Q: What is the take-home message from this report? 

MC: High total cholesterol has declined in adults 20 years from 1999-2000 to 2015-2016 and low HDL cholesterol has declined from 2007-2008 to 2015-2016.

Questions for Marissa L. Zwald, Ph.D., M.P.H., Epidemic Intelligence Service Officer and Lead Author on “Prevalence of Low High-density Lipoprotein Cholesterol Among Adults, by Physical Activity: United States, 2011-2014”

Q: Why did you conduct this study?

MZ: We produced this report because we wanted to offer statistics that highlight how regular physical activity can reduce illness from chronic diseases and premature death. In 2008, the Department of Health and Human Services released the Physical Activity Guidelines for Americans. We wanted to provide the most recent national estimates of low high-density lipoprotein (HDL) cholesterol (or serum HDL cholesterol less than 40 mg/dL) by whether or not adults met these national physical activity guidelines, and to understand how these patterns differed by sex, age, race and Hispanic origin, and education level.

Q: What caused you to focus your report on low HDL cholesterol and physical activity?

MZ: HDL cholesterol is known as the “good” cholesterol because having high levels can reduce the risk for cardiovascular disease. We know from previous research that regular physical activity can help increase HDL cholesterol levels.

Q: Was there a result in your study’s analysis that you hadn’t expected and that really surprised you?

MZ: The differences among some subgroups that we examined were quite striking. Our study confirmed that less active adults were more likely to have low HDL cholesterol. Interestingly, differences in low HDL cholesterol by physical activity were more pronounced in some subgroups we examined, including older adults (aged 60 and over), non-Hispanic whites, non-Hispanic blacks, and college graduates. More in-depth research is needed to explore why the association between physical activity and low HDL cholesterol levels is stronger for some groups than others.

Q: What differences, if any, did you see among race and ethnic groups?

MZ: Among non-Hispanic white and non-Hispanic black adults, low HDL cholesterol prevalence was significantly higher among those who did not meet the physical activity guidelines compared with those who met the guidelines.

Q: What is the take home message of this report?

MZ: I think the take home message of this report is that while sex and age can affect HDL cholesterol levels, there are also lifestyle changes that can improve HDL levels – and this includes being physically active and meeting the national physical activity guidelines.

High levels of total cholesterol and low levels of high-density lipoprotein (HDL) cholesterol (the “good cholesterol”) are risk factors for coronary heart disease. During 2009–2010, 13.4% of adults had high total cholesterol and 21.3% had low HDL cholesterol.

An NCHS report presents estimates of the percentage of adults with high total and low HDL cholesterol during 2011–2014, and trends in prevalence of high total and low HDL cholesterol from 2007–2008 to 2013–2014. Analysis is based on measured cholesterol only and does not account for cholesterol-lowering medication use.

Findings:

• During 2011–2014, 12.1% of adults had high total cholesterol and 18.5% had low high-density lipoprotein (HDL) cholesterol.
• The prevalence of high total cholesterol was lower in non-Hispanic black men than in non-Hispanic white, non-Hispanic Asian, and Hispanic men, and lower in non-Hispanic black women than in non-Hispanic white and Hispanic women.
• Low HDL cholesterol prevalence was lower in non-Hispanic black and non-Hispanic Asian men and women than in Hispanic men and women; in non-Hispanic black men and women than in non-Hispanic white men and women; and in non-Hispanic Asian women than in non-Hispanic white women.
• From 2007 to 2014, the percentage of adults with high total and low HDL cholesterol declined.