Trends in low-density lipoprotein-cholesterol blood values between 2012 and 2017 suggest sluggish adoption of the recent 2013 treatment guidelines

Background Over a 14-year period, age-adjusted high total cholesterol (>= 240 mg/dL) in the United States declined from 18.3% in 1999 to 2000 to 11.0% in 2013 to 2014, coinciding with the 2001 National Cholesterol Education Program Adult Treatment Panel (ATP)-III guidelines that endorsed low-density lipoprotein (LDL)-cholesterol blood value goals. Statin treatment recommendations were revised by the American College of Cardiology and the American Heart Association (ACC/AHA) in November 2013 to a risk-based prescription approach that did not utilize blood cholesterol values. This increased dosage and expanded the statin-eligible population by an estimated 12.8 million US adults. These changes should further lower total and LDL cholesterol concentrations nationally. Methods We examined data from 507 752 patients nationally aged >= 16 years whose fasting bloods were sent to Boston Heart Diagnostics for direct LDL-cholesterol measurements. Between 2012 and 2017, age-adjusted concentrations were examined by analysis of covariance and LDL-cholesterol >= 160 mg/dL by logistic regression. Results Contrary to expectations, age-adjusted mean LDL-cholesterol concentrations (+/- SE, mg/dL) increased significantly (P < 10(-16)) in men (2012:113.8 +/- 0.3; 2013:115.3 +/- 0.2; 2014:114.7 +/- 0.2; 2015:116.0 +/- 0.2; 2016:117.6 +/- 0.2; and 2017:117.1 +/- 0.2 mg/dL) and women (2012:119.5 +/- 0.3; 2013:120.7 +/- 0.2; 2014:119.8 +/- 0.02; 2015:120.8 +/- 0.2; 2016:122.7 +/- 0.1; and 2017:123.8 +/- 0.2 mg/dL). The percentage with LDL-cholesterol >= 160 mg/dL also increased significantly (P < 10(-9)) in men and women. Similar results were obtained for ages 40 to 75 years olds (corresponding to ACC/AHA guidelines). Conclusion These results provide additional evidence that declining blood LDL-cholesterol levels observed following the ATP-III recommendations, did not further decline (actually increased) following the 2013 ACC/AHA recommendations.