This Article Full Text Full Text (PDF) CME: Take the course for this article: Circulation: March 20, 2007, Volume 115, Number 11 Data Supplement All Versions of this Article: 115/11/1363    most recent CIRCULATIONAHA.106.645473v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Keevil, J. G. Articles by Stein, J. H. Search for Related Content PubMed PubMed Citation Articles by Keevil, J. G. Articles by Stein, J. H. Pubmed/NCBI databases Substance via MeSH Related Collections Health policy and outcome research Lipids Primary prevention Secondary prevention Risk Factors

(Circulation. 2007;115:1363-1370.)
© 2007 American Heart Association, Inc.

Health Services and Outcomes Research

Implications of Cardiac Risk and Low-Density Lipoprotein Cholesterol Distributions in the United States for the Diagnosis and Treatment of Dyslipidemia

Data From National Health and Nutrition Examination Survey 1999 to 2002

Jon G. Keevil, MD; Michael W. Cullen, MD; Ronald Gangnon, PhD; Patrick E. McBride, MD, MPH; James H. Stein, MD

From the University of Wisconsin School of Medicine and Public Health, Madison.

Correspondence to Jon G. Keevil, MD, 600 Highland Ave, MC 3248, Madison, WI 53792. E-mail jgk{at}medicine.wisc.edu

Received June 13, 2006; accepted December 22, 2006.

Background— Updated guidelines from the National Cholesterol Education Program Adult Treatment Panel III stratify patients into 5 groups of coronary heart disease (CHD) risk that determine intensity of lipid-lowering therapy. The present study assesses the distribution of low-density lipoprotein cholesterol (LDL-C) in the United States across the 5 groups of CHD risk as defined in the updated guidelines.

Methods and Results— Subjects included 7399 individuals 20 to 79 years of age in the 1999 to 2002 National Health and Nutrition Examination Survey representing 171 million individuals in the United States. CHD risk, LDL-C levels, and goal achievement were determined per Adult Treatment Panel III guidelines. CHD risk assessment incorporated a medical condition review, risk factor summation, and Framingham Risk Score calculation. Percentages were weighted to represent population estimates, and SEs were adjusted for the survey design. The distribution of individuals by CHD risk included 61.1% at lower risk, 10.6% at high risk, and 5.7% at very high risk. From Adult Treatment Panel III criteria, only 5.4% of the population was at "intermediate" risk. Two thirds (66.3%) met their Adult Treatment Panel III–defined LDL-C goal. Of those at high and very high risk, 23% and 26%, respectively, met the goal of LDL-C <100 mg/dL, whereas only 3.1% and 4.6% had an LDL-C <70 mg/dL (or non–high-density lipoprotein C <100 mg/dL).

Conclusions— Most adult US residents are at lower 10-year CHD risk and meet risk-adjusted LDL-C goals. However, large portions of the high-risk population are undertreated. The commonly described population at intermediate risk is small. A novel method of identifying patients who might benefit from additional testing to determine their treatment strategy is provided.

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