1 table omitted
High blood cholesterol is a major modifiable risk factor for atherosclerotic
cardiovascular disease.1 Two national health objectives for 2010
are to reduce to 17% the proportion of adults with high total blood cholesterol
levels and to increase to 80% the proportion of adults who had their blood
cholesterol checked during the preceding 5 years (objectives 12-14 and 12-15).2 In addition, an overall national health objective is to eliminate
racial/ethnic and other disparities in all health outcomes.2 During
1960-1994, total blood cholesterol levels among the overall U.S. population
declined; however, levels have changed little since then,3,4 despite
increases in cholesterol screening and awareness.5 To assess racial/ethnic
and other disparities among persons who were screened for high blood cholesterol
during the preceding 5 years and among persons who were aware of their high
blood cholesterol, CDC analyzed data from the 1999-2000 and 2001-2002 National
Health and Nutrition Examination Surveys (NHANES). This report summarizes
the results of that analysis, which indicated that Mexican Americans, blacks,
and younger adults were less likely to be screened for high blood cholesterol,
and persons in those populations who had high cholesterol were less likely
to be aware of their condition. Efforts are needed to encourage persons, especially
among these populations, to seek screening and gain awareness of high blood
The 1999-2000 and 2001-2002 NHANES conducted by CDC were designed to
be nationally representative of the noninstitutionalized, U.S. civilian population
on the basis of a complex, multistage probability sample. Persons with low
incomes, persons aged ≥60 years, blacks, and Mexican Americans were oversampled.
For this analysis, data from the two surveys were aggregated to increase sample
size. For this report, only participants classified as Mexican American, non-Hispanic
white, or non-Hispanic black were included. All persons in this report referred
to as white or black are non-Hispanic; Mexican Americans might be of any race.
Interviews were conducted both in English and Spanish. For 1999-2002, the
examined response rate among persons in the sample was 78.1%. Data were collected
from 8,112 survey participants aged ≥20 years who were interviewed in their
homes and subsequently provided blood samples for cholesterol level determination
in mobile examination centers. Participants were considered to have high blood
cholesterol if (1) testing indicated their total cholesterol level was ≥240
mg/dL or (2) they reported currently taking cholesterol-lowering medication,
regardless of their test result. Subjects were asked whether they had their
blood cholesterol checked during the preceding 5 years and whether they had
ever been told by a health professional that they had high blood cholesterol.
Estimated population numbers, prevalences, and 95% confidence intervals
(CIs) were calculated by using statistical analysis software to account for
nonresponse and complex sampling design. The percentages of persons in various
populations with high cholesterol levels or who had undergone blood cholesterol
screening were age-standardized to the 2000 U.S. standard population.6 Odds ratios (ORs) and CIs were obtained by using logistic regression
models that included age, sex, and race/ethnicity. All results in this report
are statistically significant (p<0.05) unless otherwise indicated.
During 1999-2002, the overall age-adjusted prevalence of cholesterol
screening was 63.0%, corresponding to approximately 106 million (CI = 102
million–109 million) persons in the United States. Disparities in cholesterol
screening were observed by age, sex, and race/ethnicity. The likelihood of
having had blood cholesterol screening within the preceding 5 years increased
with age. Women were more likely than men (adjusted OR [AOR] = 1.20; CI =
1.03-1.39) to have had their cholesterol checked during the preceding 5 years.
Blacks were less likely than whites (AOR = 0.70; CI = 0.57-0.84) and Mexican
Americans were less likely than whites (AOR = 0.43; CI = 0.35-0.53) to have
had their cholesterol checked during the preceding 5 years.
The percentage of U.S. adults with high blood cholesterol levels increased
with age. On the basis of test results only, the age-adjusted prevalence of
high blood cholesterol levels overall was 17.2%, which corresponds to approximately
29 million (CI = 27 million–31 million) persons in the United States.
On the basis of either test results or use of cholesterol-lowering medication,
the overall prevalance of high blood cholesterol was 24.6%, which corresponds
to approximately 41 million (CI = 39 million–43 million) persons. Prevalence
of measured high blood cholesterol or use of cholesterol-lowering medication
was lower among blacks (AOR = 0.74; CI = 0.60-0.91) and Mexican Americans,
respectively, when compared with whites (AOR = 0.70; CI = 0.59-0.84), after
adjustment for age and sex.
Overall, 63.3% of participants whose test results indicated high blood
cholesterol or who were on a cholesterol-lowering medication had been told
by ahealth professional they had high cholesterol before the survey. The likelihood
of this awareness increased with age. Women were less likely than men (AOR
= 0.68; CI = 0.50-0.91) to be aware of their condition. Blacks were less likely
than whites (AOR = 0.67; CI = 0.51-0.89), and Mexican Americans were less
likely than whites (AOR = 0.47; CI = 0.33-0.67) to be aware of their condition;
less than half (42%) of Mexican Americans with high cholesterol were aware
of their condition.
Reported by: AZ Fan, MD, KJ Greenlund, PhD,
S Dai, MD, JB Croft, PhD, Div of Adult and Community Health, National Center
for Chronic Disease Prevention and Health Promotion, CDC.
CDC Editorial Note: This analysis indicates
that, in 1999-2002 the proportions of blacks and Mexican Americans who had
been screened for high blood cholesterol during the preceding 5 years was
lower than the proportion for whites. The proportions of blacks and Mexican
Americans with high blood cholesterol who had been told by a health professional
of their condition also was lower than the proportion for whites. In addition,
younger adults were less likely than older persons to be screened for and
aware of their high cholesterol condition. Although women participants were
more likely than men to have had their cholesterol checked during the preceding
5 years, those women whose test results indicated high cholesterol or who
were on cholesterol-lowering medication were less likely than men to be aware
of their high cholesterol condition. A previous study determined that women
were only half as likely as men to have their total blood cholesterol controlled
at <200 mg/dL, the level considered desirable.4
Participants in the study described in this report were defined as having
high cholesterol if they had a measured total blood cholesterol level ≥240
mg/dL or reported taking cholesterol-lowering medication; this combination
resulted in a higher prevalence estimate (24.6%) than the measured results
alone (17.2%). NHANES data have previously indicated that the prevalence of
high blood cholesterol levels among U.S. adults aged 20-74 years, as determined
by testing only, decreased from 27.8% during 1976-1980 to 19.7% during 1988-1994.3 The prevalence for the same age range obtained from NHANES 1999-2002
was 17.4%; however, the mean serum total cholesterol of U.S. adults has changed
little since the 1988-1994 survey.4 The decreasing prevalence of
high blood cholesterol as measured by laboratory tests likely reflects increased
use of cholesterol-lowering medication. Persons who have lowered their cholesterol
by using medication might have other cardiovascular risk factors (e.g., high
blood pressure) that place them at higher risk than persons with naturally
lower cholesterol levels.7 Determining the prevalence of high blood
cholesterol by accounting for persons using cholesterol-lowering medication,
in addition to testing, might provide a more complete estimate of the health
burden related to high blood cholesterol.
The findings in this report are subject to at least two limitations.
First, data were only collected from persons in the noninstitutionalized population;
persons residing in nursing homes or other institutions were not included.
Second, only non-Hispanic blacks and Mexican Americans were oversampled in
NHANES 1999-2002; consequently, estimates could not be calculated for other
minority populations (e.g., Asians, Pacific Islanders, American Indians, Alaska
Natives, and other Hispanic subpopulations).
The National Cholesterol Education Program (NCEP) recommends that all
adults aged ≥20 years have their cholesterol checked at least every 5 years.8 The data in this analysis indicated that approximately 63% of U.S.
adults had their cholesterol checked during the preceding 5 years, below the
national health objective of 80% for 2010. Public health campaigns to raise
awareness of the cardiovascular disease risk associated with high blood cholesterol
levels should focus particularly on blacks, Mexican Americans, younger adults,
and women. Ongoing campaigns conducted by the American College of Cardiology;
National Heart, Lung, and Blood Institute; and American Heart Association
are aimed at raising awareness of this risk among women.9 NCEP
provides guidelines on therapeutic lifestyle changes in nutrition, physical
activity, weight control, and drug therapy, to achieve desirable cholesterol
levels.8 Physician adherence to guidelines that emphasize more
intensive cholesterol-lowering treatment for patients at higher cardiovascular
risk can also help lower the U.S. health burden related to high blood cholesterol.10
References: 10 available
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 1
Customize your page view by dragging & repositioning the boxes below.
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.