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DYSLIPIDEMIA

Trends in Statin Use and Low-Density Lipoprotein Cholesterol Levels Among US Adults: Impact of the 2001 National Cholesterol Education Program Guidelines

Assistant Professor of Medicine, Mount Sinai School of Medicine, New York, NY

Kristi Reynolds, PhD MPH

Research Scientist/Epidemiologist, Kaiser Permanente Southern California, Pasadena, CA

Donald Smith, MD

Associate Professor of Medicine, Mount Sinai School of Medicine

Paul Muntner, PhD

Associate Professor of Community and Preventive Medicine, Mount Sinai School of Medicine

Reprints: Dr. Mann, Mount Sinai School of Medicine, 1 Gustave Levy Place, Box 1087, New York, NY, 10029, fax 212/831-8116, devin.mann{at}mssm.edu

BACKGROUND: Few data are available on the use of statins after publication of the National Cholesterol Education Program Third Adult Treatment Panel (ATP-III) guidelines in 2001.

OBJECTIVE: To determine changes in statin use and its impact on low-density lipoprotein cholesterol (LDL-C) control among US adults from 1999 to 2004.

METHODS: High LDL-C levels and statin use among 1911 participants of the National Health and Nutrition Examination Survey (NHANES) 2003–2004 were determined and compared with 1770 and 2094 participants of NHANES 1999–2000 and NHANES 2001–2002, respectively. Statin use was obtained from review of participants' drug containers. High LDL-C levels and LDL-C control were defined, using risk-specific cut-points from the ATP-III guidelines.

RESULTS: Statins were taken by 24 million Americans in 2003–2004, an increase from 12.5 million in 1999–2000. In 1999–2000, 2001–2002, and 2003–2004, statins were being used by 19.6%, 27.3%, and 35.9% of US adults with high LDL-C levels, respectively (p trend <0.001). Age-standardized mean LDL-C declined from 119.9 to 112.0 to 100.7 mg/dL among statin users between 1999–2000, 2001–2002, and 2003–2004. LDL-C control to ATP-III recommended targets was achieved by 49.7%, 67.4%, and 77.6% of statin users in 1999–2000, 2001–2002, and 2003–2004, respectively (p trend <0.001). Among US adults with high LDL-C, after multivariate adjustment, non-Hispanic blacks were 39% less likely (prevalence ratio = 0.61; 95 CI 0.39 to 0.97) than non-Hispanic whites to be taking statins.

CONCLUSIONS: Statin use continues to increase among US adults and this has led to substantial improvements in LDL-C control. Nevertheless, suboptimal statin use, especially among racial/ethnic minorities, continues to prevent the maximal public health benefit from this effective drug class.

Key Words: low-density lipoprotein cholesterol, National Cholesterol Education Program Third Adult Treatment Panel, statins

Published Online, July 23, 2008. www.theannals.com, DOI 10.1345/aph.1L181