A new study published this week found that the proportion of American adults with high levels of low-density lipoprotein (LDL or “bad”) cholesterol fell by around one third between 1999 and 2006, but concluded that too many are still not being screened or treated for the condition. In an accompanying editorial, experts called for simpler national guidelines for cholesterol screening that are based on risk for developing coronary heart disease rather than fixed thresholds for LDL cholesterol.

The study was the work of Dr Elena V Kuklina, of the Centers for Disease Control and Prevention, Atlanta, and colleagues, and appears in the 18 November issue of JAMA, Journal of the American Medical Association.

The main public health thrust for managing cholesterol in the US is to tackle high levels of LDL cholesterol under guidelines from the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III).

These guidelines set targets for LDL cholesterol based on the history or risk for developing coronary heart disease (CHD) in the next 10 years.

Yet, wrote the authors, not many studies have looked at the prevalence of high LDL cholesterol and the use of medication to lower it across all categories of CHD risk.

For the study, Kuklina and colleagues examined trends in LDL cholesterol prevalence, screening, and use of drugs to lower cholesterol across four time frames: 1999 to 2000, 2001 to 2002, 2003 to 2004, and 2005 to 2006.

They took their data from the National Health and Nutrition Examination Survey (NHANES), covering only participants aged 20 and above who fasted before giving samples, but leaving out groups like pregnant women, or any with missing data. The final number of participants was 7,044.

The results showed that overall prevalence for high levels of LDL cholesterol fell from 31.5 per cent in 1999-2000 to 21.2 per cent in 2005-2006.

However, this trend varied substantially by CHD risk category.

The group with the highest proportion of participants with high levels of LDL cholesterol was the ATP III risk category, with 69.4 per cent in 1999-2000 and 58.9 per cent in 2005-2006.

The ATP III risk category group included participants with a self-reported history of CHD, angina, heart attack, stroke, and diabetes mellitus or participants with a fasting blood glucose level of 126 mg/dL or greater.

The authors found no significant changes in the weighted age-standardized screening rates across the four time frames from 1999-2000 to 2005-2006.

Of the participants showing high levels of LDL cholesterol, 35.5 per cent were unscreened, 24.9 per cent were undiagnosed, and 39.6 per cent were untreated or inadequately treated in 2005-2006, wrote the authors.

Also, in the high risk CHD group, about 20 per cent were eligible for cholesterol lowering medication but were not receiving it in 2005-2006, they added.

The authors concluded that:

“Among the NHANES population aged 20 years or older, the prevalence of high LDL-C levels decreased from 1999-2000 to 2005-2006. In the most recent period, the prevalence was 21.2 per cent.”

“Self-reported use of lipid-lowering medications increased from 8.0 per cent to 13.4 per cent, but screening rates did not change significantly, remaining less than 70 per cent during the study periods,” they added.

The researchers also commented that lack of agreement about the age at which screening should start could be getting in the way of having a clear goal about how to improve screening rates.

In an accompanying editorial about how to improve the approach to managing cholesterol, JAMA contributing editor Dr J Michael Gaziano of the VA Boston Healthcare System and Brigham and Women’s Hospital, Boston, and Dr Thomas A Gaziano of Brigham and Women’s Hospital and Harvard School of Public Health, Boston, wrote that the guidelines should be simpler.

They said that even though we have got better at finding and treating patients with high cholesterol, the current guidelines are too complicated, and as the data in the study suggests, an approach based on CHD risk would be simpler.

“Abandoning the fixed LDL-C threshold and targets used in many guidelines is justified by the linear relationship of cholesterol lowering and the benefit of the intervention for preventing cardiovascular disease,” wrote the editors.

“The use of a simplified risk-based approach could increase the ease of implementation of treatment and increase the number of patients receiving beneficial lipid-lowering therapy,” they added.

“Trends in High Levels of Low-Density Lipoprotein Cholesterol in the United States, 1999-2006.”

Elena V. Kuklina, Paula W. Yoon, Nora L. Keenan.

JAMA, Vol. 302 No. 19, November 18, 2009

Source: JAMA Archives.

Written by: Catharine Paddock, PhD

Copyright: Medical News Today

Not to be reproduced without permission of Medical News Today

According to Margaret Hamburg, Commissioner of the Aliment and Drug Administration (FDA), apropos that aliment labels may mislead consumers about the comestible bulk of their articles accept bent the absorption of the agency. She stated, “We are searching actual actively at this issue.” As an archetype of ambiguous characterization information, Hamburg acicular out that although a amalgamation characterization may accurately affirmation that the artefact central contains no auto fat, it can abort to acquaint consumers that the artefact contains a top allotment of saturated fat. In addition, both types of fat can drag bad cholesterol. She aswell mentioned that one accepted Smart Choices-approved atom in fact contains added than 40 percent sugar.

In aegis of Smart Choices, a autonomous nutrition-labeling program, administrator Mike Hughes committed to plan with the FDA apropos labeling issues but said, “The Smart Choices Affairs was developed during an accessible and diffuse collaborative activity that included some of the a lot of able and able professionals in diet science.” He again added, “And, we agenda that the Smart Choices Affairs complies with all U.S. laws and regulations.”

The appulse of candy aliment on consumers has been a affair for some time, but until now, the FDA labeling rules accept remained focused on the admittance of the Diet Facts Console that is amid on the aback ancillary of aliment products. This console lists the bulk of calories and bulk of nutrients independent aural anniversary serving. Abounding candy foods contains top amounts of sugar, salt, sodium and added capacity that accord to obesity, which in about-face may advance to the access of diabetes and added abiding diseases.

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The aliment industry accumulation in Washington accepted as The Grocery Manufacturers Association has agreed to plan with the FDA in free what diet advice would be advantageous for consumers. In addition, Hamburg beatific a accounting appeal to the aliment industry, for the development of labeling standards for the foreground of packaging. In her letter, she mentioned the simple to accept autonomous labeling arrangement in abode in Britain, which uses a traffic-light attribute to announce high, average or low levels of salt, saturated fat, amoroso and added called capacity in their articles based on government set rules.

The FDA is currently alive on the development of a angle that would ascertain appropriate belief to be met by manufacturers and retailers above-mentioned to authoritative claims on their aliment labels.

According to Margaret Hamburg, Commissioner of the Aliment and Drug Administration (FDA), apropos that aliment labels may mislead consumers about the comestible bulk of their articles accept bent the absorption of the agency. She stated, “We are searching actual actively at this issue.” As an archetype of ambiguous characterization information, Hamburg acicular out that although a amalgamation characterization may accurately affirmation that the artefact central contains no auto fat, it can abort to acquaint consumers that the artefact contains a top allotment of saturated fat. In addition, both types of fat can drag bad cholesterol. She aswell mentioned that one accepted Smart Choices-approved atom in fact contains added than 40 percent sugar.

In aegis of Smart Choices, a autonomous nutrition-labeling program, administrator Mike Hughes committed to plan with the FDA apropos labeling issues but said, “The Smart Choices Affairs was developed during an accessible and diffuse collaborative activity that included some of the a lot of able and able professionals in diet science.” He again added, “And, we agenda that the Smart Choices Affairs complies with all U.S. laws and regulations.”

The appulse of candy aliment on consumers has been a affair for some time, but until now, the FDA labeling rules accept remained focused on the admittance of the Diet Facts Console that is amid on the aback ancillary of aliment products. This console lists the bulk of calories and bulk of nutrients independent aural anniversary serving. Abounding candy foods contains top amounts of sugar, salt, sodium and added capacity that accord to obesity, which in about-face may advance to the access of diabetes and added abiding diseases.

Although consumers accept become acclimatized to the Diet Facts Panels and accept activate them accessible and informative, the addictive commercial on the foreground of packaging that touts of advantageous aliment getting independent aural has lulled abounding consumers into getting beneath acceptable to analysis the aback panel, according to Hamburg. Therefore, the FDA will not alone activate analytical these labels, but will aswell amerce companies accepting “explicit or adumbrated comestible agreeable claims” that are inconsistent with federal labeling rules. As federal law prohibits the use of apocryphal or ambiguous claims on aliment labels, the FDA has the ascendancy to yield activity adjoin companies that do not attach to federal labeling rules. Disciplinary activity adjoin a aggregation can ambit from a admonishing letter, to imposed fines, or even artefact seizures.

The aliment industry accumulation in Washington accepted as The Grocery Manufacturers Association has agreed to plan with the FDA in free what diet advice would be advantageous for consumers. In addition, Hamburg beatific a accounting appeal to the aliment industry, for the development of labeling standards for the foreground of packaging. In her letter, she mentioned the simple to accept autonomous labeling arrangement in abode in Britain, which uses a traffic-light attribute to announce high, average or low levels of salt, saturated fat, amoroso and added called capacity in their articles based on government set rules.

The FDA is currently alive on the development of a angle that would ascertain appropriate belief to be met by manufacturers and retailers above-mentioned to authoritative claims on their aliment labels.