Prevalence Of LDL-C Research Articles

Low-Density Lipoprotein Cholesterol, Cardiovascular Risk Factors, and Predicted Risk in Young Adults.

Young adults with elevated LDL-C may experience increased burden of additional cardiovascular disease (CVD) risk factors. It is unclear how much LDL-C levels, a modifiable factor, correlate with non-LDL-C CVD risk factors among young adults or how strongly these CVD risk factors are associated with long-term predicted CVD risk. We quantified clustering of non-LDL-C CVD risk factors by LDL-C among young adults to assess the association between non-LDL-C and LDL-C risk factors with predicted CVD risk in young adults. The current analysis is a cross-sectional study of adults < 40 years with an LDL-C< 190 mg/dL participating in the National Health and Nutrition Examination Survey (NHANES) between January 2015 and March 2020. We measured the prevalence of non-LDL-C risk factors by LDL-C and association between LDL-C and non-LDL-C risk factors with predicted risk of CVD by the Predicting Risk of cardiovascular disease EVENTs (PREVENT) equations. Among 2108 young adults, the prevalence of LDL-C ≥ 130 mg/dL was 15.5%. Compared with young adults with LDL-C < 100 mg/dL, those with LDL-C 100-< 130, 130-< 160, and 160-< 190 mg/dL had greater non-LDL-C risk factors. Both LDL-C and non-LDL-C risk factors were independently associated with a 30-year risk of CVD (OR 1.05, 95% CI 1.03-1.07 and OR 1.17, 95% CI 1.12-1.23, respectively). The association of LDL-C and 30-year risk did not vary by non-LDL-C risk factor burden (pinteraction = 0.43). Non-LDL-C risk factors cluster among increasing levels of LDL-C in young adults. Greater guidance on how to manage cardiovascular risk factors in young adults is needed.

The expanding needs on lipid-lowering treatment in patients with acute coronary syndrome by applying newly issued definition of extreme high-risk by Chinese Society of Cardiology

Objective: To assess the expanding needs on lipid-lowering treatment in patients with acute coronary syndrome (ACS) by applying newly issued definition of extreme high-risk, which is proposed by Chinese expert consensus on lipid management of extreme high-risk atherosclerotic cardiovascular disease (ASCVD) patients of Chinese Society of Cardiology (CSC). Methods: Data of this study was derived from the Improving Care for Cardiovascular Disease in China (CCC) project, which was a case-based nationwide registry study and launched as a collaborative initiative by the American Heart Association and the CSC. The project consecutively recruited ACS patients from158 tertiary hospitals and 82 second hospitals across China, and detailed clinical information of patients was collected. This study enrolled ACS inpatients in CCC project from November 2014 to July 2019. The proportion of extreme high-risk patients, their characteristics, mean LDL-C levels at admission, the gap between measured LDL-C level and the new target, and lipid-lowering therapy at discharge were assessed. Results: Among 104 516 ACS inpatients enrolled in this study, 75.1% (78 527/104 516) met the criteria of extreme high-risk and were expected to achieve the new LDL-C goal. Among patients at extreme high-risk, 21.2% (16 651/78 527) had multiple severe ASCVD events and 78.8% (61 876/78 527) had 1 severe ASCVD event and at least two high-risk factors. For the extreme high-risk patients, the mean level of LDL-C at admission was (2.8±1.0) mmol/L, prevalence of LDL-C ≥1.4 mmol/L was 93.4% (73 307/78 527) and the median gap between LDL-C level at admission and the target of 1.4 mmol/L was 1.3 (0.8, 2.0) mmol/L. If LDL-C could be further reduced to 50% of the admission level, we estimated that 55.6% (43 632/78 527) of the extreme high-risk patients would achieve the new LDL-C goal. Among 40 875 patients with information about discharge statin dosage, 93.5% (28 004/29 947) of the extreme high-risk patients were prescribed with statins at discharge, and among them 95.1% (26 632/28 004) received statin monotherapy and 91.1% (25 501/28 004) were at moderate doses of statins. Conclusion: About three fourth of inpatients with ACS were categorized as extreme high-risk based on the new definition of CSC expert consensuses, nine out of ten patients at extreme high-risk didn't achieve the new LDL-C target at admission, and the intensity of lipid-lowering therapy was insufficient in clinical practice. There are substantially expanding needs for implementing more intensive and effective lipid-lowering strategies.

Abstract P088: Trends in Serum Lipids in US Youth Ages 6 to 19 Years: National Health and Nutrition Examination Survey 2003 to 2014

Introduction: Between 1988-94 and 2007-10, total cholesterol (TC), non-HDL-C, HDL-C, LDL-C, and triglycerides (TG) showed favorable trends in US youth. We tested the hypotheses that these favorable trends continued in the more recent period 2003-14 and that favorable trends were also seen in apolipoprotein B (apoB). Methods: We analyzed cross-sectional data in 15,712 youths aged 6-19 years from 6 NHANES surveys: 2003-04, 2005-06, 2007-08, 2009-10, 2011-12, and 2013-14. We applied survey weights to generate US population-level estimates and used multivariate linear regression to test for time-dependent trends in lipid levels, separately by sex and age group (6-11 vs. 12-19 years). Fasting LDL-C, TG and apoB were available only at ages ≥12 years; pubertal stage was not available. Results: See Figure. TC and non-HDL-C generally showed significant decreasing linear trends in mean levels and favorable linear trends in the prevalence of ideal versus adverse levels, but these improvements were smaller and not significant in 12-19 year-old females. Conversely, HDL-C generally showed an unfavorable downward trend over time, a finding that reached borderline significance in 12-19 year-old females (β=-0.3 mg/dL per year, p=0.054), and the prevalence of HDL-C &lt;40 mg/dL increased significantly in this group (β=0.6%, p=0.02). Despite the unfavorable HDL-C trend, TG showed significant favorable linear trends in mean levels and patterns of ideal versus adverse levels in both male and female 12-19 year-olds. LDL-C and apoB showed neutral to favorable patterns, with significant linear trends for an increase in the prevalence of LDL-C&lt;110 mg/dL (β=0.5%, p=0.02) and a decrease in the prevalence of apoB ≥110 mg/dL (β=-0.9%, p=0.03) for 12-19 year-old females. Conclusions: Favorable trends in lipids were generally seen in US youth from 2003-14, with a notable exception for HDL-C. It will be important to understand factors contributing to these trends.

0084: Big data and LDL: heterozygous familial hypercholesterolemia is common in France

Heterozygous Familial Hypercholesterolemia (HeFH) is a severe autosomal dominant disease which is under-diagnosed. The prevalence of HeFH has rarely been assessed in an unselected sample from the general population. Based on a huge sample of lipid panels, we assessed the prevalence of individuals classified with definite or probable HeFH (Dutch Lipid Clinic Network (DLCN) criteria) >5 that is to say LDL-cholesterol (LDL-C) >6.5mmol/L (251mg/dL). From 2006 to 2015, 200 620 LDL-C were obtained from 105 398 subjects in a large database of a French University Hospital. Subjects from 0 to 102 years (53.7±20.5) and of both genders were analysed. LDL-C levels were calculated with the Friedewald or the Planella formula if elevated triglycerides. We also assessed the prevalence of all DLCN LDL-C criteria: 4.0-4.9mmol/L (155-190mg/dL); 5.0-6.4mmol/L (191-250mg/dL); 6.5-8.4mmol/L (251-325mg/dL); >8.5mmol/L (>325mg/dL). The prevalence of LDL-C between 4.0 and 4.9mmol/L was 9.81% [95% CI: 9.68-9.94]; the prevalence of LDL-C between 5.0 and 6.4mmol/L was 2.41% [95% CI: 2.35-2.48]; the prevalence of LDL-C between 6.5 and 8.4mmol/L was 0.37% [95% CI: 0.34-0.39] and the prevalence of LDL-C >8.5mmol/L was 0.09% [95% CI: 0.08-0.10]. In the first lipid determinations of 105 398 subjects, the prevalence of LDL-C between 4.0 and 4.9mmol/L was 10.77% [95% CI: 10.6-11.0]; between 5.0 and 6.4mmol/L was 2.47% [95% CI: 2.38-2.56]; between 6.5 and 8.4mmol/L was 0.28% [95% CI: 0.25-0.32] and of LDL-C >8.5mmol/L was 0.06% [95% CI: 0.04-0.07]. The prevalence of definite or probable HeFH was 0.46% in 200 620 lipid determinations and 0.34% in 105 398 subjects. The highest prevalence of definite or probable HeFH was in subjects aged between 35 and 55 years. In France, the prevalence of definite or probable HeFH was 1/250 adults, very closed to the observed prevalence of 1/200 obtained in the Copenhagen General Population Study.

Abstract 18274: Under Use of Statins and LDL-C Control Among People With a Framingham 10-Year Coronary Heart Disease Risk &gt; 20%

Statins reduce the incidence of coronary heart disease (CHD) in individuals with a history of CHD or risk equivalents. A 10-year CHD risk &gt;20% is considered a CHD risk equivalent but is frequently not estimated. We studied the use of statins and control of LDL-C among participants with a history of CHD or CHD risk equivalents in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study (n=30,239) The 8,812 participants with CHD or risk equivalents were categorized into four mutually exclusive groups: (1) history of CHD, (2) no history of CHD but with a history of stroke and/or aortic aneurysm, (3) no history of CHD, stroke or aortic aneurysm but with diabetes mellitus, or (4) no history of the conditions listed in (1) through (3) but with a Framingham 10-year CHD risk &gt; 20% at baseline. Lipids were measured after an overnight fast, LDL-C was calculated using the Friedewald equation, and statin use was assessed through pill bottle review during an in-home study visit. The mean age of study participants was 65 years (SD=9), 45% were women and 46% were black. In fully adjusted models, compared to those with a history of CHD, the use of statins was statistically significantly lower among people with a history of stroke/aortic aneurysm, history of diabetes, and especially 10-year CHD risk &gt; 20% (Table). Among high risk participants taking statins, the prevalence of LDL-C &lt; 100 mg/dL was similar for those with a history of CHD, a history of stroke/aortic aneurysm and diabetes, but participants with a 10-year CHD risk &gt; 20% were less likely to have an LDL-C &lt; 100 mg/dL. These data suggest many people with high CHD risk, especially those with a FRS &gt;20%, were not receiving guideline-concordant lipid-lowering therapy and quality improvement efforts should focus on this group.