Abstract 15889: Lack of Improvement in Low-Density Lipoprotein Cholesterol Goal Attainment in the United States: A Time-Sensitivity Analysis From the National Health and Nutrition Examination Survey 2003-2010
Introduction: Despite national guidelines and greater use of LDL-C-lowering drugs, patients are still not reaching recommended LDL-C goals. We assessed the prevalence of suboptimal LDL-C levels as a function of time in the National Health and Nutrition Examination Survey (NHANES) to determine proportions of the US population not at guideline-recommended goal since publication of the NCEP ATP III guidelines.
Methods: Fasting blood serum data from NHANES 2003-2010 were used to categorize adults ≥20 years of age by their LDL-C levels over 2-year increments using NCEP ATP III definitions based on CHD risk. SAS 9.2 was used for cross-sectional analyses. The Taylor series expansion method was used for variance estimates.
Results: The estimate of population for the US (50 states plus the District of Columbia) was based on 8,653 observations from the NHANES Complex Survey data. As shown in the sample and projected data in the Table, the number of patients reaching LDL-C goals over the 2-year increments did not improve, irrespective of cardiovascular risk. There were no statistically significant differences between groups over the entire follow-up period. This was especially true among high-risk (CHD or CHD risk-equivalent [10-year risk >20%]) and moderately high-risk patients (2+ risk factors [10-year risk 10%-20%]).
Conclusions: This analysis of NHANES data demonstrated a lack of any trend for improvement in LDL-C goal attainment from 2003-2010, even as more physicians became familiar with current lipid management guidelines. Especially concerning is that the large majority of high-risk and moderately high-risk patients are still not attaining their risk-stratified LDL-C goal, despite the availability of efficacious lipid-lowering therapy. Reassessment of current educational approaches and the manner of guideline implementation is urgently needed to improve LDL-C goal attainment rates and more impactfully reduce risk for cardiovascular disease.
- © 2013 by American Heart Association, Inc.