Introduction: Ideal low density lipoprotein (LDL) levels are associated with lower cardiovascular disease morbidity and mortality and the National Cholesterol Education Program has identified LDL as the primary target for cholesterol lowering treatment. The prevalence of poor LDL has decreased since the 1970’s, however 27% of U.S. adults still have poor LDL levels. Few studies have characterized the transitions from ideal to intermediate to poor LDL levels in different life epochs and in minorities using contemporary data.
Methods: Cross-sectional 2007-2012 National Health and Nutrition Examination Survey (NHANES) data (N = 11,140) and 2008-2011 Hispanic Community Health Study/Study of Latinos (HCHS/SOL) data (N = 15,262) were used to estimate the age-, race-, and sex- specific prevalence of ideal (<100 mg/dL untreated), intermediate (100-140 mg/dL or treated to goal), or poor (>140 mg/dL) among European American (EA), African American (AA) and Hispanic/Latino (HL) adults ≥20 years of age. We then used these data and novel Markov-type models to estimate race/ethnic- and sex-specific net transition probabilities between ideal, intermediate, and poor LDL.
Results: At age 20 the prevalence of ideal LDL ranged from 44% (HL men) to 64% (EA women).Variation in the loss of ideal LDL was also observed by race/ethnicity and gender. For example, among EA men aged 20, a net 4.6% (95% CI: 3.9%-5.3%) transitioned from ideal to intermediate LDL levels by age 21, net transitions that were 30% higher than net transitions estimated for EA women aged 20, for whom a net 3.3% (95% CI: 2.3%-4.3%) transitioned from ideal to intermediate LDL levels by age 21. Movement from ideal to intermediate LDL levels in adulthood also peaked at earlier ages among men (EA=27, AA=28, and HL= 31) than among women (EA=36, AA=35, and HL=45), with the largest transitions occurring among EA men [net transition probability of 5.6% (95% CI: 4.6%-6.6%)]. In addition, net transition patterns favored movement from intermediate to poor LDL levels across the life course, with adult net transitions peaking at age 20 among EA and AA men and approximately 10 years later among EA women, AA women, and HL men. Net transitions peaked at the latest ages among HL women [age 36, net transition probability = 2.7% (95% CI: 2.4%-3.1%)].
Conclusions: Loss of ideal LDL begins early in life and shows divergent patterns by gender and race. Difficulties re-attaining ideal LDL once classified as intermediate or poor support interventions that promote ideal LDL levels in younger ages, especially in men.