Lack of awareness, treatment of high cholesterol more common among Black, Hispanic adults

Diseases of the Body

Lack of awareness, treatment of high cholesterol more common among Black, Hispanic adults

By FYH News Team

Published on November 2, 2023

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November 01, 2023

2 min read

Key takeaways:

One in four U.S. adults with an LDL of 190 mg/dL or higher is unaware or untreated.
Black, Hispanic and socially disadvantaged adults are most likely to be unaware of their high cholesterol.

Among U.S. adults with elevated LDL, being unaware and untreated was more common among Black and Hispanic adults and those with lower income or without health insurance, data from the National Health and Nutrition Examination Survey show.

“Although pharmacotherapy is indicated for LDL levels of 190 mg/dL or greater and may be considered at 160 mg/dL to 189 mg/dL, awareness and treatment levels may be suboptimal given unsatisfactory screening levels despite long-standing recommendations,” Salim S. Virani, MD, PhD, FAHA, vice provost for research and professor at Aga Khan University and staff member and adjunct professor at Texas Tech Heart Institute and Baylor College of Medicine, and colleagues wrote in JAMA Cardiology.

Cholesterol_Test_AdobeStock — One in four U.S. adults with an LDL of 190 mg/dL or higher is unaware or untreated.
*Source: Adobe Stock*

In a cross-sectional study, Virani and colleagues analyzed data from 23,667 adults across 10 consecutive cycles of NHANES (1999-2000 to 2017-2020), of whom 7.8% had an LDL of 160 mg/dL to 189 mg/dL and 2.8% had an LDL of 190 mg/dL or higher. The researchers classified participants as “unaware” of their LDL status if they never had an LDL measurement or were never informed of having an elevated LDL, and as “untreated” if medications did not include a statin, ezetimibe, a bile acid sequestrant or a PCSK9 inhibitor.

The researchers investigated temporal trends using logistic regression analyses with survey cycle as the independent variable.

Nationally, the age-adjusted prevalence of an LDL of 160 mg/dL to 189 mg/dL fell over time, from 12.4% (95% CI, 10-15.3) in 1999-2000 to 6.1% (95% CI, 4.8-7.6) in 2017-2020 (P < .001). The age-adjusted prevalence of an LDL of 190 mg/dL or greater declined from 3.8% (95% CI, 2.8-5.2) in 1999-2000 to 2.1% (95% CI, 1.4-3) in 2017-2020 (P = .001).

Among those with an LDL of 160 mg/dL to 190 mg/dL, the proportion of those who were unaware and untreated declined from 52.1% (95% CI, 41-63) in 1999-2000 to 42.7% (95% CI, 33.6-52.3) in 2017-2020. For those with an LDL of 190 mg/dL or greater, the proportion of those who were unaware or untreated declined from 40.8% (95% CI, 26.9-56.3) in 1999-2000 to 26.8% (95% CI, 12.6-48.2) in 2017-2020.

Salim S. Virani

“Although the prevalence of severely elevated LDL has declined, one in 17 U.S. adults still have LDL levels of 160 mg/dL to 189 mg/dL and one in 48 adults have LDL levels of 190 mg/dL or greater,” the researchers wrote. “Among those with an LDL of 190 mg/dL or greater, one in four are unaware and untreated, with a higher proportion for an LDL of 160 mg/dL to 189 mg/dL.” The researchers noted that the gaps in awareness and treatment disproportionately affect Black, Hispanic and socioeconomically disadvantaged adults, contributing to disparities in outcomes.

Younger adults were also more likely to be unaware or have untreated elevated LDL.

“Strategies to identify and treat these individuals may improve outcomes and reduce disparities,” the researchers wrote. “This lack of awareness and treatment may be due to difficulties accessing primary care, low rates of screening in primary care, lack of consensus on screening recommendations, insufficient emphasis on LDL as a quality measure and hesitance to treat asymptomatic individuals.”

The researchers also noted that the survey-based analysis was limited by a small number of participants with elevated LDL and dependency on participant recall of whether LDL was previously measured.

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Sources/Disclosures

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Disclosures:
Virani reports receiving grants from the NIH, U.S. Department of Veterans Affairs and the Tahir and Jooma Family and honorarium for serving as associate editor for innovations for the American College of Cardiology. Please see the study for all other authors’ relevant financial disclosures.

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