Trends in Lipid Concentrations and Lipid Control Among US Adults, 2007-2018

Aggarwal, Rahul; Bhatt, Deepak L.; Rodríguez, Fátima; Yeh, Robert W.; Wadhera, Rishi K.

doi:10.1001/jama.2022.12567

Cited by 37 publications

(32 citation statements)

References 33 publications

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“…Treatment in adults with diabetes was defined as a self-report of taking pills for diabetes or insulin. Control was assessed among adults receiving treatment for each respective condition, consistent with prior reports . Hypertension was considered controlled if systolic blood pressure was less than 140 mm Hg and diastolic blood pressure was less than 90 mm Hg.…”

Section: Methodsmentioning

confidence: 99%

“…[4][5][6] Recent analyses suggest a rise in prediabetes among adolescents and obesity among the youngest adults (aged 18-25 years). 7,8 In addition, shifts in guidelines from the American College of Cardiology and American Heart Association (ACC/AHA), [9][10][11] along with health policy initiatives (eg, Medicaid expansion under the Affordable Care Act) that expanded access to insurance coverage and health care for young adults, [12][13][14][15][16] have likely influenced population-level treatment rates and risk factor control. Understanding trends in cardiovascular risk factor prevalence, treatment, and control among young adults is critical from a public health standpoint given recent data suggesting that cardiovascular disease and death rates may now be increasing in this population.…”

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confidence: 99%

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Cardiovascular Risk Factor Prevalence, Treatment, and Control in US Adults Aged 20 to 44 Years, 2009 to March 2020

Aggarwal

Yeh

Maddox

et al. 2023

JAMA

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109

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ImportanceDeclines in cardiovascular mortality have stagnated in the US over the past decade, in part related to worsening risk factor control in older adults. Little is known about how the prevalence, treatment, and control of cardiovascular risk factors have changed among young adults aged 20 to 44 years.ObjectiveTo determine if the prevalence of cardiovascular risk factors (hypertension, diabetes, hyperlipidemia, obesity, and tobacco use), treatment rates, and control changed among adults aged 20 to 44 years from 2009 through March 2020, overall and by sex and race and ethnicity.Design, Setting, and ParticipantsSerial cross-sectional analysis of adults aged 20 to 44 years in the US participating in the National Health and Nutrition Examination Survey (2009-2010 to 2017–March 2020).Main Outcomes and MeasuresNational trends in the prevalence of hypertension, diabetes, hyperlipidemia, obesity, and smoking history; treatment rates for hypertension and diabetes; and blood pressure and glycemic control in those receiving treatment.ResultsAmong 12 924 US adults aged 20 to 44 years (mean age, 31.8 years; 50.6% women), the prevalence of hypertension was 9.3% (95% CI, 8.1%-10.5%) in 2009-2010 and 11.5% (95% CI, 9.6%-13.4%) in 2017-2020. The prevalence of diabetes (from 3.0% [95% CI, 2.2%-3.7%] to 4.1% [95% CI, 3.5%-4.7%]) and obesity (from 32.7% [95% CI, 30.1%-35.3%] to 40.9% [95% CI, 37.5%-44.3%]) increased from 2009-2010 to 2017-2020, while the prevalence of hyperlipidemia decreased (from 40.5% [95% CI, 38.6%-42.3%] to 36.1% [95% CI, 33.5%-38.7%]). Black adults had high rates of hypertension across the study period (2009-2010: 16.2% [95% CI, 14.0%-18.4%]; 2017-2020: 20.1% [95% CI, 16.8%-23.3%]), and significant increases in hypertension were observed among Mexican American adults (from 6.5% [95% CI, 5.0%-8.0%] to 9.5% [95% CI, 7.3%-11.7%]) and other Hispanic adults (from 4.4% [95% CI, 2.1%-6.8%] to 10.5% [95% CI, 6.8%-14.3%]), while Mexican American adults had a significant rise in diabetes (from 4.3% [95% CI, 2.3%-6.2%] to 7.5% [95% CI, 5.4%-9.6%]). The percentage of young adults treated for hypertension who achieved blood pressure control did not significantly change (from 65.0% [95% CI, 55.8%-74.2%] in 2009-2010 to 74.8% [95% CI, 67.5%-82.1%] in 2017-2020], while glycemic control among young adults receiving treatment for diabetes remained suboptimal throughout the study period (2009-2010: 45.5% [95% CI, 27.7%-63.3%]) to 2017-2020: 56.6% [95% CI, 39.2%-73.9%]).Conclusions and RelevanceIn the US, diabetes and obesity increased among young adults from 2009 to March 2020, while hypertension did not change and hyperlipidemia declined. There was variation in trends by race and ethnicity.

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Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

Cardiovascular Risk Factor Prevalence, Treatment, and Control in US Adults Aged 20 to 44 Years, 2009 to March 2020

Aggarwal

Yeh

Maddox

et al. 2023

JAMA

Self Cite

109

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“…According to a meta-analysis by Ezzati and his colleagues, similar extent of the increase was found in New Zealand, Switzerland and United Kingdom 14) . In contrast, HDL showed only moderate increase in the United States at most by 4 % and 5 % in men and women, respectively, for the period 1988-2002, respectively 12,13) , and almost flat in more recent years 2007-2018 15) .…”

Section: Hdl Increase and Nutritional Shiftmentioning

confidence: 88%

“…Accordingly, LpAI (HDL containing apoA-I but not apoA-II) 10) has almost doubled while LpAI:AII (HDL containing the both) tended to decrease during this period in Japan 11) . The trend of plasma HDL elevation is also observed in some other regions and countries but the extent of the increase was at most a few percent for decades in most of these countries except for a few like New Zealand, Switzerland and United Kingdom, much less than Japan 9,[11][12][13][14][15] . No specific factor has been identified for the background to account for this peculiar change in lipoprotein metabolism among Japanese.…”

Section: Chronological Trend Of Plasma Lipoproteinsmentioning

confidence: 99%

Continuous and Marked Increase of Japanese HDL Associates Paradoxically with their Nutritional Shift

Yokoyama

2023

JAT

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Aims: Plasma HDL has evidently increased for decades among Japanese, exclusively in HDL particles containing apoA-I but not A-II. Its metabolic background is yet to be elucidated. Methods: Trends in plasma lipoproteins were analyzed by examining data on total cholesterol, triglyceride and HDL-cholesterol, which are available in the public database of the National Health and Nutrition Examination Survey of Japan (NHNESJ) and in the clinical data of SRL Co., from 1989 to 2019, estimating cholesterol (C) in non-HDL, VLDL, LDL, and sub-fractions of LDL using the equations by Sampson et al. Food intake and supply data in NHNSJ and in the UN Food and Agriculture Organization were also analyzed in relation to the lipoprotein analysis.Results: HDL-C levels showed a steady increase in men and women throughout the period as per the data retrieved in NHNSJ and SRL data. It is noted to be higher in women than men (from 46.8 to 52.7, and from 58.4 to 68.3 in mg/dl, respectively). Triglyceride and VLDL-C were higher in men but sex difference was not apparent in non-HDL-C and LDL-C levels, while these parameters slightly decreased in both sexes. The increase in HDL was most prominent in women in the age of 50 -59 (from 57.0 to 73.4). The age-dependent HDL trend was reversed among women during the study period, as increasing instead of decreasing. This increase in HDL was found to coincide with lowered fish/meat ratio in food intake among Japanese. Conclusion:Marked increase in plasma HDL among Japanese is age-and sex-dependent and exhibited an apparent paradoxical association with lowered fish/meat ratio in their diet. Further investigation is required to elucidate the background for these findings.

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“…In this issue of JAMA , Aggarwal and colleagues provide an analysis of trends in lipid concentrations and lipid control across different race and ethnic groups using the National Health and Nutrition Examination Survey (NHANES) databases from 2007 through 2018. The main objective of the study was to determine whether lipid concentrations changed in the US from 2007 through 2018.…”

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Reducing Disparities in Cholesterol Control

Flórez

Hunt

Valencia

2022

JAMA

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Heart disease remains the leading cause of death in the US 1,2 and also contributes to poor quality of life and disability. 1 Among the reversible risk factors for heart disease, high blood cholesterol concentration has been shown to increase cardiovascular disease (CVD) morbidity and mortality. 3 Evidence shows that interventions to help people be active; maintain a healthful weight; avoid nicotine exposure; eat a heart-healthy diet; get appropriate sleep; and control glucose, blood pressure, and cholesterol may improve and maintain cardiovascular health. 4 Statin medications that lower cholesterol levels have been available for several decades and are recommended for people at high risk of heart disease. Ensuring that high-risk individuals are taking statins can help reduce rates of CVD.Despite this knowledge, there are several recognized disparities in cardiovascular health and lipid-lowering therapies, 2,5,6 offering greater challenges for prevention and management. In the US, Black individuals are more likely to die of heart disease than non-Hispanic White individuals, and disparities also have been observed in the prevalence and control of risk factors such as obesity, hypertension, high cholesterol concentrations, and cigarette smoking. 2,5,7 A previous study 8 of claims data that included 11 411 patients with diabetes, who were followed up between 1997 to 2007, showed that despite increased rates of hypercholesterolemia testing (from 48% to 70% in Black patients, from 61% to 77% in White patients) and lipid-lowering treatment (from 23% to 56% among Black patients and from 33% to 61% among White patients), racial disparities remained not only within those parameters but also in goal attainment (defined as lowdensity lipoprotein [LDL] cholesterol <100 mg/dL [2.59 mmol/L]), with Black individuals less likely than White individuals to have attained the goal in 2007 (59% vs 76%; odds ratio [OR] 0.59; 95% CI, 0.56-0.63).In this issue of JAMA, Aggarwal and colleagues 9 provide an analysis of trends in lipid concentrations and lipid control across different race and ethnic groups using the National Health and Nutrition Examination Survey (NHANES) databases from 2007 through 2018. The main objective of the study was to determine whether lipid concentrations changed in the US from 2007 through 2018. In contrast to another recent study that focused on CVD risk factor including total cholesterol levels, 5 the analyses by Aggarwal et al encompassed trends in total, HDL, and LDL cholesterol and triglyceride concentrations specific to racial and ethnic groups. Availability of information on LDL cholesterol, HDL cholesterol, and triglycerides changes is an important distinction due to race and ethnic group-specific differences in lipids and lipoprotein levels. The secondary outcome was to determine lipid control (defined as total cholesterol <200 mg/dL; 5.18 mmol/L) among those treated with statins.

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Trends in Lipid Concentrations and Lipid Control Among US Adults, 2007-2018

Cited by 37 publications

References 33 publications

Cardiovascular Risk Factor Prevalence, Treatment, and Control in US Adults Aged 20 to 44 Years, 2009 to March 2020

Cardiovascular Risk Factor Prevalence, Treatment, and Control in US Adults Aged 20 to 44 Years, 2009 to March 2020

Continuous and Marked Increase of Japanese HDL Associates Paradoxically with their Nutritional Shift

Reducing Disparities in Cholesterol Control

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