Epidemiology of Hyperlipidemia in the U.S.

Summary and Comment |
December 17, 2009

Epidemiology of Hyperlipidemia in the U.S.

  1. Thomas L. Schwenk, MD

The high prevalence of untreated hyperlipidemia in high-risk patients requires new approaches.

  1. Thomas L. Schwenk, MD

A new study of prevalence and management of hyperlipidemia has stimulated provocative suggestions for new treatment approaches, particularly in patients at high coronary risk. Researchers used data from four National Health and Nutrition Examination Surveys (NHANES) to assess low-density lipoprotein cholesterol (LDL-C) levels and treatment in about 7000 adults from 1999 through 2006. Coronary heart disease risks were classified as high (known CHD, diabetes mellitus, or 10-year Framingham risk score >20%), intermediate (≥2 major risk factors but 10-year risk ≤20%), or low (no or 1 major CHD risk factor). The authors defined high LDL-C as ≥100 mg/dL for high-risk people, ≥130 for intermediate-risk people, and ≥160 for low-risk people.

Participant-reported screening rates remained constant at about 64% throughout the 8 years. Among participants with elevated LDL-C levels, 35% were unscreened, 25% had been screened but not told the results, and 40% had been screened but treated inadequately. The overall prevalence of high LDL-C levels declined from 32% to 21% during the study period. People at high risk were most likely to exhibit high LDL-C levels, although the prevalence dropped from 69% to 59% in this group during the study period. In high-risk participants with elevated LDL-C levels, roughly two thirds of those eligible for medication did not receive treatment.

Comment

The continued high prevalence of untreated hyperlipidemia in high-risk patients prompted two provocative commentaries. In one, the authors recommended a more aggressive treatment approach using age alone as the threshold (no age was specified), based on the low cost of generic statins and the benefits of lipid-lowering therapy across a wide spectrum of CHD risk. The other commentators suggested using CHD risk alone, rather than LDL-C level, as the indication for treatment, with the goal of lowering LDL-C levels by 50% in higher-risk patients, regardless of their baseline levels. Either approach would simplify treatment and eliminate much of the current confusion around guidelines and indications for treatment.

Citation(s):

Reader Comments (1)

Rick Frieden

Dr Schwenk describes a suggestion by the authors of one of the papers to reduce LDL-C levels by 50% in all dyslipidemic patients at high risk. Several recently published papers show an inverse correlation between LDL and intracerebral hemorrhage rates (bginning at LDL as high as 140). Given that, such a one-size-fits-all strategy would be most unwise. As always, our therapy should be tailored individually, with each patient's unique constellation of risk factors, prior history, etc., taken into account.

Competing interests: None declared

Your Comment

(will not be published)

Filtered HTML

  • Allowed HTML tags: <a> <em> <strong> <cite> <blockquote> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Do you have any conflict of interest to disclose?
CAPTCHA
This question is for testing whether you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

* Required

Reader comments are intended to encourage lively discussion of clinical topics with your peers in the medical community. We ask that you keep your remarks to a reasonable length, and we reserve the right to withhold publication of remarks that do not meet this standard.

PRIVACY: We will not use your email address, submitted for a comment, for any other purpose nor sell, rent, or share your e-mail address with any third parties. Please see our Privacy Policy.