Overall, the prevalence of high LDL–C significantly decreased from 59% in 1976–1980 to 42% in 1988–1994, and to 33% in 2001–2004, reaching 27% in 2007–2010.

No data on cholesterol-lowering medications were collected in the 1976–1980 study cycle. However, other data sources indicate that less than 1% of the population used lipid-lowering medication during the 1976–1980 time frame (5).

The percentage of adults meeting guidelines for low saturated-fat intake increased significantly from 1976–1980 to 1988–1994, from 25% to 41%, but no significant change occurred from 1988–1994 through 2007–2010 (Figure 3).

When high LDL–C, cholesterol-lowering medication use, and low saturated-fat intake during the time frame of 1976–1980 through 2007–2010 are presented together, the following patterns can be seen (Figure 4):

Among U.S. adults aged 40–74, a substantial decline in the prevalence of high LDL–C, from 59% to 27%, was observed between 1976–1980 and 2007–2010.

From 1976–1980 through 2007–2010, for U.S. adults aged 40–74, a decrease was observed in the prevalence of high LDL–C, as well as an increase in adults using lipid-lowering medications and consuming a diet low in saturated fat. A substantial decline in the prevalence of high LDL–C from 59% to 28% was seen over this same time period. There also were significant increases in the percentage of adults meeting federal dietary guidelines (6) for low dietary saturated-fat intake, from 25% to 42%, between 1976–1980 and 2007–2010; however, no significant changes were observed from 1988–1994 to 2007–2010. Although declines in the proportion of calories from saturated fat have occurred since the 1970s, the average dietary energy intake has increased (7). Use of cholesterol-lowering medication continued to grow steadily, from 5% to 23%, from 1988–1994 to 2007–2010.

Despite recent advances in medical treatment, high cholesterol remains a significant public health problem in the United States, with more than one-quarter of adults aged 40–74 having high LDL–C. These findings may provide useful information for evaluation of programs and policy initiatives aimed at reducing the prevalence of high cholesterol in the adult population.

Note: For all definitions listed, the denominator is total population.

Data from NHANES conducted during four study cycles—1976–1980, 1988–1994, 2001–2004, and 2007–2010—for adults aged 40–74 were used in this report. NHANES is a cross-sectional survey designed to monitor the health and nutritional status of the civilian noninstitutionalized U.S. population. The survey consists of interviews conducted in participants’ homes and standardized physical examinations in mobile examination centers (MECs), including laboratory tests. One-half of participants aged 12 and over who participated in the MEC exam were randomly assigned to the morning sample and instructed to fast for at least 8 hours up to 24 hours prior to venipuncture. The prevalences of high LDL–C are based on persons examined in the morning and fasting for 8.5 up to 24 hours prior to venipuncture. The dietary saturated-fat data for this report were collected from in-person, 24-hour dietary recall interviews in the MEC. Dietary recalls cover intake during the day (24 hours) prior to the standardized physical examination at the MEC. Improvement in dietary intake methodology and food composition databases, as well as changes in food composition, occurred during the time frame of 1976–1980 through 2007–2010 (7).

All variances were estimated by Taylor series linearization. Prevalence estimates were age adjusted by the direct method to the 2000 U.S. census population using the age groups 40–59 and 60–74. The following sample weights were incorporated in prevalence estimates and standard errors: fasting subsample weights for high LDL–C; interview weights for cholesterol medication use; MEC weights for saturated-fat intake estimates for 1976–1980 and 1988–1994; and dietary day-one weights for 2001–2004 and 2007–2010. Differences between groups were tested using a t statistic with the appropriate number of degrees of freedom at the p < 0.05 significance level. Adjustments were not made for multiple comparisons. Statistical hypotheses of no linear trends were tested using orthogonal contrasts matrices. Statistical analyses were conducted using SAS release 9.3 (SAS Institute, Cary, N.C.) and SUDAAN release 10.0 (RTI International, Research Triangle Park, N.C.).