From the American College of Cardiology: The AP (4/24, Stobbe) reports that according to a report released today by the Centers for Disease Control and Prevention, “only 13 percent of US adults have high total cholesterol.” Health experts theorize that “it’s largely because so many Americans take cholesterol-lowering drugs, but dropping smoking rates and other factors also contributed.” CDC researchers released the report after examining data from “interviews and blood tests of nearly than 6,000 US adults in 2009 and 2010.”
Blogfinger Medical Commentary: by Paul Goldfinger, MD, FACC (Note: Cholesterol levels are written as 240 mg/dL, but we will just write the number.)
This data from the National Center for Health Statistics is a big thrill for those physicians who have been active in promoting cardiovascular prevention. The CDC was surprised by this result, since they expected that 17% of the adult population would have high total cholesterol (i.e. over 240,) whereas the result came out to be 13.4 %. In 1999-2000, the result was 18.3%. This change since 1999 represents a decline of 27% in total cholesterol levels. (Total cholesterol refers to all the cholesterol in the blood—good and bad)
There were other observations that were of interest when the data was broken down into sub-categories. Given the lifesaving potential of cholesterol control, it is worrisome that 1/3 of adults were not screened with blood tests for high cholesterol over the last 5 years.
When the total cholesterol numbers were checked according to sex and age, in the age group of 40-59, the trend downward occurred for men, but not for women. This finding requires further analysis. Women came out better after age 60.
As for the reasons for the declining cholesterol numbers, this is complicated and was not discussed in the CDC report.
There is one caveat:
This trend analysis uses 240 as a cutoff, saying that levels above 240 are “high” and that 87% of adults over age 20 have levels that are not high. But that doesn’t mean that any number under 240 is “low” or “safe.” The average cholesterol level in the US has dropped from 222 to about 200 in recent years. The American Heart Association says that anything over 200 carries an increased risk. The average cholesterol level for patients with coronary heart disease is 225.
There are countries where the average cholesterol levels are 150, and those places have the lowest risk of coronary heart disease. There is no number which is “normal,” and each person who is assessed for cholesterol risk has a target number which the physician chooses by looking at all the risk factors and medical history of a particular patient. The graph below, from the current CDC study, shows the percent of men and women who have “high” cholesterol plotted against the years. Note that female levels are higher than males across the board.
- This graph is part of the CDC report. Below is a link to that report.
Undoubtedly, one reason that these numbers have improved is that Americans are more conscious of eating “heart healthy.” I do believe that the widespread use of statin drugs is also affecting the results. Diet, especially including reductions in saturated fats, will improve total cholesterol numbers, but the results are often not dramatic. The quote below is from our 2011 book “Prevention Does Work: A Guide to a Healthy Heart” by Paul and Eileen Goldfinger:
“It is important to realize that most low fat diets generally lower cholesterol levels by only modest amounts (usually in the 10-20% range). The amount of cholesterol lowering that occurs with diet is quite variable, depending largely on genetic factors and patient compliance. Diets form the foundation of efforts to correct abnormal blood lipids, but often medications must be added in order to achieve excellent results.”