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Primary Prevention of High Blood Cholesterol Concentrations in the United States
David C. Goff, Jr, MD, PhD;
Darwin R. Labarthe, MD, PhD;
George Howard, DrPH;
Gregory B. Russell, MS
Arch Intern Med. 2002;162:913-919.
Background Mean concentrations of total cholesterol (TC) among adults have declined
in the United States for decades. Whether the decline has been owing to prevention
of high TC levels or treatment of high TC levels once present is not known.
Objective To determine whether population-wide influences and/or the high-risk
approach have been operating to produce the well-known decline in mean TC
concentration in the US population.
Methods We examined changes in the distribution of TC levels across US birth
cohorts as sampled in the National Health Examination Survey and the National
Health and Nutrition Examination Surveys I, II, and III. We tested the hypotheses
that the age-adjusted 10th, 25th, 50th, 75th, and 90th percentiles of TC levels
were lower in more recent US birth cohorts than in earlier cohorts.
Results Data were analyzed for 49 536 participants born between 1887 and
1975 and examined at ages 18 through 74 years between 1959 and 1994. The 10th,
25th, 50th, 75th, and 90th percentiles of TC levels (adjusted for age, race,
and sex) were estimated to be lower by 3.4, 3.9, 4.7, 5.7, and 7.1 mg/dL (0.09,
0.10, 0.12, 0.15, and 0.18 mmol/L), respectively, for every successive 10
years in date of birth (P<.001 for each estimate).
Conclusions The declines in TC levels associated with successive birth cohorts were
greater at the upper aspect of the distribution, probably because of the combination
of population influences and treatment effects. The differences seen at the
lower percentiles support the contention that a strong prevention effect occurred
in the US population from 1959 through 1994. Greater understanding of this
dramatic shift in the distribution of TC levels could support future prevention
efforts.
From the Department of Public Health Sciences, Wake Forest University
School of Medicine, Winston-Salem, NC (Dr Goff and Mr Russell); Division of
Adult and Community Health, National Center for Chronic Disease Prevention
and Health Promotion, Centers for Disease Control and Prevention, Atlanta,
Ga (Dr Labarthe); and Department of Biostatistics, University of Alabama at
Birmingham School of Public Health (Dr Howard).
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