Article Figures & Data
Tables
- Table 1.
LDL-C Goal and Cut Point Levels for Therapeutic Lifestyle Changes and Drug Therapy by Risk Category, NCEP ATP III
Risk Category Goal mg/dL Initiate Therapeutic Lifestyle Changesamg/dL Drug Therapyb mg/dL CHD = coronary heart disease; LDL-C = low-density lipoprotein cholesterol; NCEP ATP III = National Cholesterol Education Program Adult Treatment Panel III. aPersons at high risk or moderately high risk who have lifestyle-related risk factors (eg, obesity, physical inactivity, elevated triglyceride level, low HDL-C level, or metabolic syndrome) are candidates for therapeutic lifestyle changes to modify these risk factors regardless of LDL-C level. bLDL-C lowering drug therapy, when given, should be sufficient to reduce LDL-C levels ≥30%–40%. cCHD includes history of myocardial infarction, unstable angina, stable angina, coronary artery procedures (angioplasty or bypass surgery), or evidence of clinically significant myocardial ischemia. dCHD equivalents include clinical manifestations of noncoronary forms of atherosclerotic disease (peripheral arterial disease, abdominal aortic aneurysm, and carotid artery disease, such as transient ischemic attacks or stroke of carotid origin or >50% obstruction of a carotid artery), diabetes, and ≥2 risk factors with a 10-year risk for hard CHD >20%. eCHD risk factors include cigarette smoking, hypertension (blood pressure =140/90 mm Hg or taking antihypertensive medication), low high-density lipoprotein cholesterol (<40 mg/dL), family history of premature CHD (CHD in male first-degree relative aged <55 years; CHD in female first-degree relative aged <65 years), and age (men =45 years; women =55 years). Electronic 10-year risk calculators are available at http://www.nhlbi.nih.gov/guidelines/cholesterol. fAlmost all persons with ≤1 risk factor have a 10-year risk <10%; thus, a 10-year risk assessment is unnecessary. High: CHDc or CHD equivalentd (10-y risk >20%) <100 ≥100 ≥100 (<100: consider drug options) Intermediate: ≥2 risk factorsc (10-y risk ≤20%)e <130 ≥130 ≥130: 10-y risk 10%-20% (100–129: consider drug options) ≥160: 10-y risk <10% Low: ≤1 risk factorf <160 ≥160 ≥190 (160–189: LDL-lowering drug optional) - Table 2.
Sociodemographic Characteristics and CHD Risk Factors for Men Aged 20 to 35 Years and Women Aged 20 to 45 Years, NHANES, 1999–2006
Characteristic Total No. All % (SE) Men % (SE) Women % (SE) CHAMPUS = Civilian Health and Medical Program of the Uniformed Services; CHD = coronary heart disease; NA = not available; NCEP ATP III = National Cholesterol Education Program Adult Treatment Panel III; NHANES = National Health and Nutrition Examination Survey; SE = standard error. aCalculated as total family income/poverty threshold index adjusted for family size, composition, and location at year of interview: low (≤1: family income less than or equal to poverty threshold index); medium (2–3: family income 2 to 3 times as high as poverty threshold index); and high (>3: family income >3 times as high as poverty threshold index). bHaving private insurance, Medicaid, or CHAMPUS/Veterans Affairs insurance. cAssessed by responses to the question, “During the past 12 months, how many times have you seen a doctor or other health care professional about your health at a doctor’s office, a clinic, hospital emergency room, at home or some other place?” dSelf-reported coronary heart disease, angina, myocardial infarction, stroke, or diabetes (self-reported or fasting blood glucose =126 mg/dL). eSystolic blood pressure >140 mm Hg, diastolic blood pressure >90 mm Hg, or reporting a prescription medication for hypertension. fSelf-reported. gBody mass index ≥30 kg/m2 (weight in kilograms divided by the square of height in meters). hCHD or CHD equivalent or ≥2 major CHD risk factors and a 10-year Framingham risk >20%. iTwo or more major CHD risk factors and a 10-year Framingham risk ≤20%. jOne or no major CHD risk factor. kRelative SE ≥30%, estimate is unreliable. Sex Male 1,041 38.8 (1.1) 100 Female 1,546 61.2 (1.1) 100 Race/ethnicity Non-Hispanic white 1,110 65.6 (1.7) 62.3 (2.3) 67.7 (1.7) Non-Hispanic black 587 12.6 (1.1) 11.5 (1.4) 13.3 (1.2) Mexican-American 651 10.5 (1.0) 13.5 (1.3) 8.6 (0.9) Other 239 11.3 (1.4) 12.7 (1.9) 10.4 (1.4) Education Less than high school 657 18.2 (1.1) 20.9 (1.7) 16.6 (1.3) High school 633 25.7 (1.3) 29.6 (2.0) 23.2 (1.4) More than high school 1,294 56.0 (1.6) 49.5 (1.8) 60.2 (2.0) Poverty indexa 1 475 15.0 (0.9) 13.7 (1.1) 15.8 (1.2) 2–3 1,007 39.4 (1.4) 43.5 (2.1) 36.7 (1.4) ≥3 921 45.7 (1.5) 42.8 (2) 47.4 (1.5) Medical insuranceb Yes 1,746 73.1 (1.2) 64.8 (1.8) 78.4 (1.3) No 841 26.9 (1.2) 35.2 (1.8) 21.6 (1.3) Times received health care during last 12 moc 0 626 21.7 (0.9) 35 (1.5) 13.3 (1.0) 1 576 22.1 (0.8) 25.6 (1.3) 20 (1.1) 2–3 1,086 44.2 (1.1) 32.8 (1.5) 51.4 (1.3) ≥4 299 12.0 (0.7) 6.6 (0.9) 15.4 (1.0) CHD or CHD equivalentd 126 4.6 (0.4) 2.7 (0.6) 5.9 (0.7) Risk factors High blood pressuree 286 10.9 (0.7) 11.2 (1.2) 10.6 (0.9) Smokingf 557 24.1 (1.0) 26.9 (1.4) 22.3 (1.3) Family historyf 356 15.9 (0.8) 13.8 (1.3) 17.2 (1.1) Obesityg 791 28.3 (1.0) 23.6 (1.4) 31.3 (1.3) ≥2 436 17.9 (1.1) 17.6 (1.4) 18.0 (1.3) 1 965 37.3 (1.0) 39.6 (1.7) 35.9 (1.4) 0 1,060 40.2 (1.1) 40.1 (1.8) 40.3 (1.3) NCEP ATP III risk categories Highh 131 4.8 (0.5) 3.0 (0.5) 6.0 (0.7) Intermediatei 300 13.1 (0.9) 17.7 (1.5) 10.1 (0.9) Lowj 2,156 82.1 (1.1) 79.3 (1.6) 83.9 (1.1) Currently taking lipid-lowering medications 36 1.7 (0.3) NAk 2.3 (0.5) - Table 3.
Screening by Number of Risk Factors Among Men Aged 20 to 35 Years and Women Aged 20 to 45 Years (N = 2,587), NHANES, 1999–2006
Risk Factora Screeningb % (SE) Screeningc Risk Ratio (95% CI) CHD=coronary heart disease; CI=confidence interval; NHANES = National Health and Nutrition Examination Survey; SE = standard error. aHigh blood pressure, smoking, family history, and obesity. bSelf-reported cholesterol screening within the last 5 years. cN = 2,402 due to missing data. Each model was adjusted for race/ethnicity, education, poverty status, medical insurance status, and health care access during last 12 months, and age (continuous). dSelf-reported coronary heart disease, angina, myocardial infarction, stroke, or diabetes (self-reported or fasting blood glucose ≥126 mg/dL). All CHD or CHD equivalentd 67.7 (5.7) 1.5 (1.1–2.2) ≥2 47.4 (3.0) 1.2 (1.0–1.4) 1 45.1 (2.3) 1.2 (1.0–1.4) 0 41.8 (1.8) Referent Men 20–35 y CHD or CHD equivalentd 63.6 (10.9) 2.40 (1.40–4.13) ≥2 37.9 (4.8) 1.30 (0.87–1.94) 1 35.9 (2.7) 1.36 (1.01–1.84) 0 30.0 (2.4) Referent Women 20–45 y CHD or CHD equivalentd 68.9 (6.6) 1.32 (0.89–1.96) ≥2 53.4 (3.9) 1.12 (0.90–1.39) 1 51.6 (2.8) 1.10 (0.90–1.34) 0 49.3 (2.2) Referent - Table 4.
Prevalence and Standard Errors of High LDL-C Levels by Number of Risk Factors Among Men Aged 20 to 35 Years and Women Aged 20 to 45 Years (N = 2,587), NHANES, 1999–2006
Risk Factorsa High LDL-Cb % (SE) High LDL-Cb,c Risk Ratio (95% CHD = coronary heart disease; CI = confidence interval; LDL-C = low-density lipoprotein cholesterol; NHANES = National Health and Nutrition Examination Survey. aRisk factors: high blood pressure, smoking, family history, and obesity. bLDL-C ≥100, ≥130, and ≥160 mg/dL for high, intermediate, and low NCEP ATP III risk categories, respectively. cN = 2,402 due to missing data. Each model was adjusted for race/ethnicity, education, poverty status, medical insurance status, and health care access during last 12 months, and age (continuous). dSelf-reported coronary heart disease, angina, myocardial infarction, stroke, or diabetes (self-reported or fasting blood glucose ≥126 mg/dL). eLinear trend across risk categories assessed by calculating orthogonal polynomial coefficients according to the method of Fisher and Yates; P value for linear trends <.001. All CHD or CHD equivalentd 65.1 (4.2) 12.8 (8.8;18.5) ≥2 25.9 (2.6) 4.0 (2.7;5.9) 1 12.5 (1.3) 1.8 (1.3;2.6) 0 6.7 (0.8)e Referent Men 20–35 y CHD or CHD equivalentd 55.1 (10.1) 5.6 (1.6;11.9) ≥2 27.5 (3.8) 2.8 (1.5;5.1) 1 13.9 (1.9) 1.2 (0.7–2.1) 0 10.1 (1.7)e Referent Women 20–45 y CHD or CHD equivalentd 68 (4.9) 21.1 (13.4;33.3) ≥2 24.9 (3.1) 5.7 (3.5;9.2) 1 11.6 (1.8) 2.6 (1.5; 4.4) 0 4.6 (0.8)e Referent
Additional Files
The Article in Brief
Prevalence of Coronary Heart Disease Risk Factors and Screening for High Cholesterol Levels Among Young Adults, United States, 1999−2006
Elena V. Kuklina , and colleagues
Background Young adults receive cholesterol screening at low rates in the United States. This study examined the national prevalence of risk factors for coronary heart disease (CHD) and compliance with cholesterol screening guidelines among young adults.
What This Study Found Approximately two-thirds of all young adults have one or more risk factors for CHD, yet less than 50 percent are screened for high cholesterol levels. About 59 percent of young adults had CHD or CHD equivalents, or one or more risk factors (high blood pressure, smoking, family history or obesity). The prevalence of high cholesterol increased with the number of CHD risk factors, yet there was no significant difference in screening for cholesterol among those with one, two, or more risk factors for CHD compared with those with no risk factors. High cholesterol levels were observed in 65 percent of young adults with CHD or CHD equivalents, 26 percent of young adults with two or more risk factors, 12 percent of young adults with one risk factor, and 7 percent with no risk factors.
Implications
- The authors call for clinical and public health programs to improve risk assessment and management of cardiovascular disease in young adults.
