Many US Adults Still Above LDL-C Thresholds Despite 2-Decade Decline

Mean low-density lipoprotein cholesterol (LDL-C) levels declined among US adults and adolescents without atherosclerotic cardiovascular disease (ASCVD) or statin use from 1999 to 2023, but the pace of improvement may have slowed and many individuals remained above clinically relevant thresholds, according to a brief report published in Circulation.

The investigators analyzed nationally representative National Health and Nutrition Examination Survey (NHANES) data from 1999-2000 through 2021-2023. LDL-C was calculated with the Martin-Hopkins equation in fasting participants aged 12 years and older; individuals who were pregnant, reported ASCVD, or used statins were excluded. The authors noted that the 2026 American College of Cardiology/American Heart Association/Multisociety Dyslipidemia Guideline reinstated risk-based LDL-C treatment goals for adults and emphasized early detection and treatment, including in childhood.

Among 21,150 adults, age-standardized mean LDL-C decreased from 130mg/dL in 1999-2000 to 115mg/dL in 2021-2023. The decline was steep through 2003-2004, plateaued through 2009-2010, and then resumed gradually. The proportion with LDL-C of 100mg/dL or higher fell from 81.2% to 64.1%, and the proportion with LDL-C of 160mg/dL or higher fell from 18.1% to 9.9%.

In combined 2013-2023 data, LDL-C distributions were more favorable among women than men, and adults aged 40 to 59 years had the least favorable distribution of any age group. Among 7,725 adolescents aged 12 to 19 years, mean LDL-C decreased from 92mg/dL to 88mg/dL. The proportion with LDL-C of 100mg/dL or higher declined from 35.6% to 29.6%, with a plateau after 2009-2010, and the proportion with LDL-C of 130mg/dL or higher declined from 9.2% to 6.7%.

The authors concluded that the findings underscore the need for earlier identification of elevated LDL-C, sustained lifestyle and pharmacologic prevention strategies, and more effective implementation of guideline-directed lipid management across the life course. They noted that analyses were limited to the fasting subsample and that some subgroup estimates may be less precise because of smaller sample sizes.

Source: Lyon S, de Ferranti SD, Moran AE, Zhang Y. Trends and distribution of low-density lipoprotein cholesterol levels among US adults and adolescents without atherosclerotic cardiovascular disease, 1999 to 2023. Circulation. 2026;154(15):1510-1514. doi:10.1161/CIRCULATIONAHA.126.080677