Abstract 29: Loss of Ideal Total Cholesterol Early in Life: The National Health and Nutrition Examination Survey (NHANES)

Abstract

Introduction: Ideal total blood cholesterol (TC) levels are associated with lower cardiovascular disease (CVD) morbidity and mortality. In the U.S. TC increases up to middle age, but declines at older ages. Few studies have characterized the transition from ideal to intermediate and poor TC levels in different life epochs and in minorities. Methods: Cross-sectional 2007-2012 NHANES data (N = 11,140) were used to estimate the age-, race-, and sex- specific prevalence of ideal (≥20 years: <200 mg/dL untreated, 16-19 years: <170 mg/dL), intermediate (≥20 years: 200-239 mg/dL or treated to goal, 16-19 years: 170-199 mg/dL), and poor (≥20 years: ≥240 mg/dL, 16-19 years: ≥200 mg/dL) TC, defined per American Heart Association criteria. We then used these data and novel Markov-type models to estimate net transition probabilities between ideal, intermediate and poor TC. Results: Between the ages of 16 and 18, the prevalence of ideal TC among European American (EA) and African American (AA) men was approximately 68%, notably higher than the prevalence in EA women (63%) and AA women (61%). Variation in the loss of ideal TC was also observed by race and sex. Between 16-50 years of age, the proportion of AA men, EA men and EA women with ideal levels of TC declined approximately 2.0% (95% CI: 1.8%, 2.2%) per year. In AA women by contrast, the age-specific decline in ideal TC was not uniform between 16-50 years of age. The proportion of AA women with ideal levels of TC declined 0.7% (95% CI: 0.2%, 1.2%) per year from 16-20 years of age but increased to 2.8% (95% CI: 2.4%, 3.3%) per year by age 50. Among populations with intermediate TC levels, estimated 1-year net transitions to poor TC peaked at age 16, the earliest age under investigation, for EA men, EA women, and AA men but remained stable for AA women through 70 years of age, where a net 0.6% (95% CI: 0.1%, 1.3%) of the population with intermediate TC levels transitioned to poor TC levels one year later. In all demographic groups and life epochs, greater proportions of the population transitioned from intermediate to poor TC than from poor to intermediate TC. Conclusions: Loss of ideal TC begins early in life and shows divergent patters by gender and race. Difficulties re-attaining ideal TC once classified as intermediate or poor support interventions that promote ideal TC levels in younger ages, especially among AA women.