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State of the Cholesterol Nation: Levels Are Lower, But Prescription Use Is Up

America’s 2014 cholesterol report card is out, and the grades are mixed.

On a positive note, total serum cholesterol levels continue to trend downward as people heed messages from their healthcare providers to pay attention to their numbers.

But the number of people with elevated cholesterol, high LDL cholesterol, and low HDL levels is too high, according to statistics from the Centers for Disease Control and the American Heart Association. And, a significant increase in the use of cholesterol-lowering medications is underway, with estimates that up to 12.8 million more people will be prescribed cholesterol-lowering drugs, including 87% of men and 54% of women 60-75 years old.

Between 1988 and 1994, the mean serum cholesterol level for 20+ year-old adults was 206 mg/dl. By 2012, the mean decreased 5.3% to 195 mg/dl. But while total cholesterol levels are decreasing, the number of people with elevated cholesterol, elevated LDL, or low HDL levels remains too high, according to the latest data from the American Heart Association and the Centers for Disease Control.

Nearly 100 million adults have levels of 200 mg/dl or more. Of these, about 32 million have levels at or above 240 mg/dl. Moreover, 7.8% of teens ages 12-19 have levels of 200 mg/dl or higher.

Back on the plus side, the AHA reported that LDL cholesterol levels decreased significantly over the last three decades. In the late 70s, nearly six out of ten people had high LDL levels (defined as 160 mg/dL or less for low-risk groups, 130 mg/dL or less for intermediate-risk groups, and 100 mg/dL or less for high-risk groups). By 2010, that percentage was down to 27%.

The decrease is attributable to two factors, according to the AHA. Over the same period, the number of adults who shifted to a low saturated-fat diet jumped from 25% to 41%. Healthier eating and regular exercise, along with other lifestyle changes, are known to influence cholesterol levels.

However, the drop in LDL cholesterol also is due to a major increase in prescriptions for cholesterol-lowering medications. According to the Centers for Disease Control, since 1988, the percentage of men taking LDL-lowering medications rose from 5% to 25%, the percentage women from 6% to 21%, the percentage of 40-64 year-olds from 4% to 19%, and the percentage of adults above 65-years old from 10% to 39%.

The trend is expected to accelerate as healthcare providers implement the American College of Cardiology (ACC) and the American Heart Association (AHA) guidelines for cholesterol management.  A study by Duke University Dr. Pencina and colleagues published in the New England Journal of Medicine estimated that 12.8 million more people will be prescribed statins for cholesterol management under the guidelines. Many would be adults 60-75 years old. The percentage of men prescribed medications is expected to rise from 30% to 87%, and the percentage of women from 21% to 54%.

As might be expected, not every healthcare professional agrees that cholesterol medications are the right path to pursue. In a New York Times editorial that generated more than 500 comments, Drs. John Abramson and Rita Redberg wrote that while prescription statins are effective for people with known heart disease, people who have less than a 20% CVD risk within a 10 year window do not receive the same benefit, and in fact, are more likely to experience side effects, including muscle pain or weakness, decreased cognitive function, increased risk of diabetes (especially for women), cataracts or sexual dysfunction.

Additionally, Abramson and Redberg argued that giving drugs to those who do not have CVD provides a false sense of security. “According to the World Health Organization, 80% of cardiovascular disease is caused by smoking, lack of exercise, an unhealthy diet, and other lifestyle factors. Statins give the illusion of protection to many people, who would be much better served, for example, by simply walking an extra 10 minutes per day.”

The discussion will continue in 2015, with both sides debating the pros and cons of prescription versus nonprescription approaches to cholesterol management. Please visit to see the latest news relating to cholesterol and maintaining healthy LDL levels..