Declining serum total cholesterol levels among US adults. The National Health and Nutrition Examination Surveys.

OBJECTIVE To examine the secular trend in serum total cholesterol levels of the US adult population. DESIGN Nationally representative cross-sectional surveys with both an in person interview and a medical examination that included the measurement of blood lipid levels. SETTING/PARTICIPANTS Between 6000 and 13,000 adults aged 20 through 74 years examined in each of four separate national surveys during 1960 through 1962, 1971 through 1974, 1976 through 1980, and 1988 through 1991. RESULTS Mean serum total cholesterol levels in US adults aged 20 through 74 years have consistently declined over the time period 1960 through 1991. More than half of the decline occurred during the time period 1976 through 1991. This decline occurred across the entire distribution of serum cholesterol levels and in all age-sex groups. High-density lipoprotein cholesterol and very low-density lipoprotein cholesterol levels have not changed, suggesting that the decline in total cholesterol levels is due to a decline in low-density lipoprotein cholesterol levels. CONCLUSIONS These results document a continuing and substantial decline in serum cholesterol levels among US adults. They suggest that public health programs, designed to reduce cholesterol levels, are proving successful. The observed downward trend in serum cholesterol levels has coincided with a continuing decline in coronary heart disease mortality. These observations suggest that the Healthy People 2000 goal of reducing the mean serum cholesterol level of US adults to no more than 200 mg/dL (5.17 mmol/L) is attainable.

[1]  J. Mckenney,et al.  Summary of the second report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II) , 1993, JAMA.

[2]  M. Carroll,et al.  Serum lipids of adults 20-74 years: United States, 1976-80. , 1993, Vital and health statistics. Series 11, Data from the National Health Survey.

[3]  B. Rockhill,et al.  Improved cholesterol-related knowledge and behavior and plasma cholesterol levels in adults during the 1980s. , 1992, JAMA.

[4]  K. Maurer,et al.  Sample design: Third National Health and Nutrition Examination Survey. , 1992, Vital and health statistics. Series 2, Data evaluation and methods research.

[5]  R. Clark.  Report of the expert panel on population strategies for blood cholesterol reduction , 1992 .

[6]  G. T. Hunter,et al.  Report of the Expert Panel on Population Strategies for Blood Cholesterol Reduction. A statement from the National Cholesterol Education Program, National Heart, Lung, and Blood Institute, National Institutes of Health. , 1991, Circulation.

[7]  A. Folsom,et al.  Trends in serum cholesterol levels from 1980 to 1987. The Minnesota Heart Survey. , 1991, The New England journal of medicine.

[8]  N. Santanello,et al.  Change in cholesterol awareness and action. Results from national physician and public surveys. , 1991, Archives of internal medicine.

[9]  D. Gordon,et al.  A Single Cholesterol Measurement Underestimates the Risk of Coronary Heart Disease: An Empirical Example From the Lipid Research Clinics Mortality Follow-up Study , 1990 .

[10]  R. Briefel,et al.  Selection of nutrition status indicators for field surveys: the NHANES III design. , 1990, The Journal of nutrition.

[11]  A M Stephen,et al.  Trends in individual consumption of dietary fat in the United States, 1920-1984. , 1990, The American journal of clinical nutrition.

[12]  A. Folsom,et al.  Continued decline in cardiovascular disease risk factors: results of the Minnesota Heart Survey, 1980-1982 and 1985-1987. , 1990, American journal of epidemiology.

[13]  M. Carroll,et al.  Serum lipids and lipoproteins of Hispanics, 1982-84. , 1990, Vital and health statistics. Series 11, Data from the National Health Survey.

[14]  M. Welch,et al.  A comparison of results for cholesterol in human serum obtained by the Reference Method and by the Definitive Method of the National Reference System for cholesterol. , 1990, Clinical chemistry.

[15]  J. Cleeman,et al.  The National Cholesterol Education Program. , 1989, Clinics in laboratory medicine.

[16]  C. Sempos,et al.  Divergence of the recent trends in coronary mortality for the four major race-sex groups in the United States. , 1988, American journal of public health.

[17]  McGinnis Jm,et al.  The Surgeon General's report on nutrition and health. , 1988 .

[18]  R. Burkman.  Lipid and lipoprotein changes in relation to oral contraception and hormonal replacement therapy. , 1988, Fertility and sterility.

[19]  Daniel Steinberg,et al.  Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. The Expert Panel. , 1988, Archives of internal medicine.

[20]  A. Truswell.  Evolution of dietary recommendations, goals, and guidelines. , 1987, The American journal of clinical nutrition.

[21]  J. Huttunen,et al.  Dietary determinants of plasma high-density lipoprotein cholesterol. , 1987, American heart journal.

[22]  R. Fulwood,et al.  Cardiovascular risk status and oral contraceptive use: United States, 1976-1980. , 1986, Preventive medicine.

[23]  R. Fulwood,et al.  Total serum cholesterol levels of adults 20-74 years of age. , 1986, Vital and health statistics. Series 11, Data from the National Health Survey.

[24]  C. Lenfant.  A new challenge for America: the National Cholesterol Education Program. , 1986, Circulation.

[25]  J. Karon,et al.  Accuracy and comparability of long-term measurements of cholesterol. , 1986, Clinical chemistry.

[26]  J. Hupp.  Lowering Blood Cholesterol to Prevent Heart Disease , 1985, International Journal of Technology Assessment in Health Care.

[27]  E. Cook,et al.  The decline in ischemic heart disease mortality rates. An analysis of the comparative effects of medical interventions and changes in lifestyle. , 1984, Annals of internal medicine.

[28]  P. Bachorik,et al.  High-density-lipoprotein cholesterol in heparin-MnCl2 supernates determined with the Dow enzymic method after precipitation of Mn2+ with HCO3-. , 1984, Clinical chemistry.

[29]  R. Forthofer.  Investigation of nonresponse bias in NHANES II. , 1983, American journal of epidemiology.

[30]  R. L. Rizek,et al.  7 – Current Food Consumption Practices and Nutrient Sources in the American Diet , 1982 .

[31]  J T Massey,et al.  Plan and operation of the Second National Health and Nutrition Examination Survey, 1976-1980. , 1981, Vital and health statistics. Ser. 1, Programs and collection procedures.

[32]  P. Wood,et al.  Automated determination of total plasma cholesterol: a serum calibration technique. , 1979, Clinica chimica acta; international journal of clinical chemistry.

[33]  P. Bachorik,et al.  External quality control survey of triglyceride (triacylglycerol) analyses performed by 12 lipid research clinics. , 1979, Clinical chemistry.

[34]  P. Bachorik,et al.  External quality-control survey of cholesterol analyses performed by 12 lipid research clinics. , 1978, Clinical chemistry.

[35]  P. Fu,et al.  Enzymatic determination of total serum cholesterol. , 1974, Clinical chemistry.

[36]  H. Miller,et al.  Plan and operation of the health and nutrition examination survey. United states--1971-1973. , 1973, Vital and health statistics. Ser. 1, Programs and collection procedures.

[37]  R. Levy,et al.  Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. , 1972, Clinical chemistry.

[38]  F. E. Moore,et al.  Serum cholesterol levels of adults. United States, 1960-1962. , 1967, Vital and health statistics. Series 11, Data from the National Health Survey.

[39]  R. Birkner.  PLAN AND INITIAL PROGRAM OF THE HEALTH EXAMINATION SURVEY. , 1965, Vital and health statistics. Ser. 1, Programs and collection procedures.

[40]  B. Brodie,et al.  A simplified method for the estimation of total cholesterol in serum and demonstration of its specificity. , 1952, The Journal of biological chemistry.