NHANES: Just Over Half of Eligible Patients Taking Cholesterol-Lowering Medication


More than one-third of US adults are on or are eligible for cholesterol-lowering therapy based on the 2013 American College of Cardiology/American Heart Association (ACC/AHA) clinical guidelines, yet just a little more than half of eligible patients are taking medication, according to the results of a new analysis. 

Take Home: NHANES: Just Over Half of Eligible Patients Taking Cholesterol-Lowering Medication

Among those eligible for treatment, the prevalence of medication use varies significantly by sex, with women more likely than men to be taking a prescription to lower cholesterol levels. Across different racial/ethnic populations, non-Hispanic white individuals eligible for treatment were more likely than Mexican-Americans and non-Hispanic blacks to be taking a cholesterol-lowering medication.

In their paper published December 4, 2015, in the Morbidity and Mortality Weekly Report from the Centers for Disease Control and Prevention, researchers say that despite the widespread promotion of cholesterol treatment for reducing the risk of atherosclerotic cardiovascular disease (ASCVD), more efforts are needed to put in place “patient education and disease management programs to reduce sex and racial/ethnic disparities among adults eligible for treatment of cholesterol.”

Cholesterol Guidelines Now Based On Risk, Not LDL Levels

In 2013, the ACC/AHA cholesterol guidelines eliminated the previously recommended LDL- and non-HDL–cholesterol targets. Instead, the newest iteration outlined 4 distinct groups of patients who should be started on or continue with cholesterol-lowering medications:

  • individuals with clinical ASCVD (coronary heart disease, MI, angina, or stroke) 
  • those with LDL cholesterol levels >190 mg/dL 
  • those 40 to 75 years of age without ASCVD but with diabetes and LDL cholesterol levels 70-189 mg/dL 
  • those 40 to 75 years of age without ASCVD or diabetes but with a 10-year risk of ASCVD >7.5% 

In the guidelines, statins are the go-to medication for lowering cholesterol unless contraindicated or statin-associated adverse events occur.

The new CDC report is based on data from 3,737 participants in the 2005-2012 National Health and Nutrition Examination Surveys (NHANES). Adults currently taking any cholesterol-lowering drug or who met the ACC/AHA eligibility criteria were defined as being eligible for treatment.

Extrapolating from the sample, it is estimated that 36.7%, or 78.1 million individuals aged 21 years or older, are eligible for cholesterol-lowering therapy based on the 2013 AHA/ACC recommendations. Of these, 55.5% are taking cholesterol-lowering therapy and 46.6% reported making lifestyle changes to lower their cholesterol levels. A further 37.1% of those surveyed reported concurrently making lifestyle changes and taking medication while 35.5% reported doing neither.

Prevalence of Treatment-Eligible Patients and Medication Use

Overall, more men than women were eligible for treatment—40.8% vs 32.9% of US men and women, respectively—but eligible men were less likely than women to be taking cholesterol-lowering drugs.

Differences across racial/ethnic lines were also observed. Approximately one-quarter of Mexican-Americans were eligible for therapy but just 47.1% of these individuals were taking medication to lower their cholesterol levels. For white and black individuals, 38.4% and 39.5% were eligible for treatment, respectively, and 58.0% and 46.0% were taking cholesterol-lowering medication.

The poorest uptake of treatment was observed among black individuals without regular access to health care. Despite being eligible for therapy, just 5.7% of black people without healthcare access were taking a medication for their elevated cholesterol.

Overall, the majority of eligible individuals surveyed who were making lifestyle modifications, either through exercise, diet, or weight control, also were taking a cholesterol-lowering medication. Nearly 80% of men and women making some form of lifestyle change who were eligible for drug therapy were taking a medication. Across the different racial/ethnic groups, 81% of Mexican-American, 80% of white, and 72% of black patients making changes to their lifestyle and eligible for treatment were taking a prescription to lower their cholesterol.  


Source: 
Mercado C, DeSimone AK, Odom E, et al. Prevalence of cholesterol treatment eligibility and medication use among adults—United States, 2005-2012. MMWR. 2015;64:1305-1320.

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Michael O’Riordan is the Associate Managing Editor for TCTMD and a Senior Journalist. He completed his undergraduate degrees at Queen’s…

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Disclosures
  • Authors report no conflicts of interest
  • Morbidity and Mortality Weekly is published by the Centers for Disease Control and Prevention from the US Department of Health and Human Services

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