title: Trends in low-density lipoprotein cholesterol goal achievement in high risk United States adults: longitudinal findings from the 1999-2008 National Health and Nutrition Examination Surveys.
abstract: BACKGROUND
  Previous studies have demonstrated gaps in achievement of low-density lipoprotein-cholesterol (LDL-C) goals among U.S. individuals at high cardiovascular disease risk; however, recent studies in selected populations indicate improvements.
  
  
  OBJECTIVE
  We sought to define the longitudinal trends in achieving LDL-C goals among high-risk United States adults from 1999-2008.
  
  
  METHODS
  We analyzed five sequential population-based cross-sectional National Health and Nutrition Examination Surveys 1999-2008, which included 18,656 participants aged 20-79 years. We calculated rates of LDL-C goal achievement and treatment in the high-risk population.
  
  
  RESULTS
  The prevalence of high-risk individuals increased from 13% to 15.5% (p = 0.046). Achievement of LDL-C <100 mg/dL increased from 24% to 50.4% (p<0.0001) in the high-risk population with similar findings in subgroups with (27% to 64.8% p<0.0001) and without (21.8% to 43.7%, p<0.0001) coronary heart disease (CHD). Achievement of LDL-C <70 mg/dL improved from 2.4% to 17% (p<0.0001) in high-risk individuals and subgroups with (3.4% to 21.4%, p<0.0001) and without (1.7% to 14.9%, p<0.0001) CHD. The proportion with LDL-C ≥130 mg/dL and not on lipid medications decreased from 29.4% to 18% (p = 0.0002), with similar findings among CHD (25% to 11.9% p = 0.0013) and non-CHD (35.8% to 20.8% p<0.0001) subgroups.
  
  
  CONCLUSIONS
  The proportions of the U.S. high-risk population achieving LDL-C <100 mg/dL and <70 mg/dL increased over the last decade. With 65% of the CHD subpopulation achieving an LDL-C <100 mg/dL in the most recent survey, U.S. LDL-C goal achievement exceeds previous reports and approximates rates achieved in highly selected patient cohorts.
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Tattersall
authors.forename: Ronald E
authors.initials: RE
authors.lastname: Gangnon
authors.forename: Kunal N
authors.initials: KN
authors.lastname: Karmali
authors.forename: Michael W
authors.initials: MW
authors.lastname: Cullen
authors.forename: James H
authors.initials: JH
authors.lastname: Stein
authors.forename: Jon G
authors.initials: JG
authors.lastname: Keevil
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000266:history; D008078:Cholesterol, LDL / Q000097:blood*; D005260:Female; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys / Q000706:statistics & numerical data*; D011159:Population Surveillance; D015995:Prevalence; D012016:Reference Values; D012306:Risk; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D008078:Cholesterol, LDL
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