New guidelines lead to improvement in cholesterol levels in Americans, but more work is needed

A study conducted by UAB investigators reports a decline in cholesterol levels since the 2013 cholesterol guidelines, but more needs to be done in the way of improving cardiovascular health.

LDL2Pankaj Arora, M.D.A new study published in the Journal of the American College of Cardiology by University of Alabama at Birmingham researchers shows that implementation of the 2013 American College of Cardiology/American Heart Association cholesterol guidelines resulted in the improvement of cholesterol levels among American adults, especially those on cholesterol-lowering drugs.

Nirav Patel, M.D., a resident in the Department of Medicine, explained that high cholesterol levels are implicated in the development of heart diseases and occurrence of stroke. The 2013 guidelines encouraged clinicians to treat individuals with a ‘risk-based approach’ rather than focusing on a target cholesterol level. The new guidelines divided people into four major groups to encourage the treatment of high cholesterol levels in these high-risk groups, alongside adoption of a heart-healthy lifestyle.

In the current study, the authors examined the nationwide trends in total cholesterol, triglycerides, and LDL cholesterol — bad cholesterol — levels among American adults. They also assessed the change in the awareness of having high cholesterol and the use of cholesterol-lowering medication after the publications of the guidelines, especially in the high-risk groups.

To investigate, Patel and his team analyzed the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2016, which is a biannual survey conducted by the Centers for Disease Control and Prevention, in American adults aged 20 years or older.

“The examination of the NHANES allowed us to see at a national level the change in cholesterol levels and cholesterol-lowering medication over 12 years and the role of the new guidelines on this trend,” Patel said. 

Researchers found that cholesterol levels decreased for American adults taking cholesterol-lowering medication over the years, with an additional drop after the publication of the 2013 guidelines. They also noted that awareness of having high cholesterol steadily improved among American adults, but it remained same after the release of the guidelines. 

The study highlighted that people with diabetes, who are at higher risk of heart disease, showed an increase in the use of cholesterol-lowering medication. In the subgroup of individuals with a higher likelihood of developing heart disease in the next 10 years, there was a slight decrease in the use of cholesterol-lowering medicines after the announcement of guidelines.

“From a public health point of view, the 2013 guidelines have seemingly improved overall cholesterol levels among Americans on cholesterol-lowering medication,” said senior author Pankaj Arora M.D., a physician-scientist in the UAB’s Division of Cardiovascular Disease. “More people are now eligible for treatment using the risk-based approach advocated by the guidelines rather than the previously used target-based approach. The increase in adoption of a healthier lifestyle such as a reduction in physical inactivity, smoking, and consumption of fat-rich food, has also contributed to the decrease of cholesterol levels.”

Arora added there are areas that have not improved after the implementation of the guidelines, such as awareness of high cholesterol levels and medication use in high-risk groups, who stand to benefit the most from medication. 

“Efforts are needed to further the dissemination of guidelines by targeting the gaps in the education of clinicians and improving the perception among people about the safety of cholesterol-lowering medicines,” Arora said.