MMWR Morb Mortal Wkly Rep. 2011 Feb 4;60(4):109-14.
High levels of low-density lipoprotein cholesterol (LDL-C), a major risk factor for coronary heart disease (CHD), can be treated effectively.
CDC analyzed data from 1999-2002 and 2005-2008 to examine the prevalence, treatment, and control of high LDL-C among U.S. adults aged ≥20 years. Values were determined from blood specimens obtained from persons participating in the National Health and Nutrition Examination Survey (NHANES), a nationally representative cross-sectional, stratified, multistage probability sample survey of the U.S. civilian, noninstitutionalized population. The National Cholesterol Education Program Adult Treatment Panel-III guidelines set LDL-C goal levels of <100 mg/dL, <130 mg/dL, and <160 mg/dL for persons with high, intermediate, and low risk for developing CHD during the next 10 years, respectively. A person with high LDL-C was defined as either a person whose LDL-C levels were above the LDL-C goal levels or a person who reported currently taking cholesterol-lowering medication. Control of high LDL-C was defined as having a treated LDL-C value below the goal levels.
Based on data from the 2005-2008 NHANES, an estimated 71 million (33.5%) U.S. adults aged ≥20 years had high LDL-C, but only 34 million (48.1%) were treated and 23 million (33.2%) had their LDL-C controlled. Among persons with uncontrolled LDL-C, 82.8% reported having some form of health insurance. The proportion of adults with high LDL-C who were treated increased from 28.4% to 48.1% between the 1999-2002 and 2005-2008 study periods. Among adults with high LDL-C, the prevalence of LDL-C control increased from 14.6% to 33.2% between the periods. The prevalence of LDL-C control was lowest among persons who reported receiving medical care less than twice in the previous year (11.7%), being uninsured (13.5%), being Mexican American (20.3%), or having income below the poverty level (21.9%).
The prevalence of control of high LDL-C in the United States, although improving, remains low, especially among low-income adults and those with limited access to health care. Strengthening the use of preventive services through improvement in health-care access and quality of care is expected to help achieve better control of high LDL-C in the United States.
To improve LDL-C control levels, a comprehensive approach that involves improved clinical care, as well as improved health-care access, sustainability, and affordability, is needed. A standardized system of patient care incorporating electronic health records, registries, and automated reminders for practitioners, focusing on achieving regular patient follow-up, has the potential to improve control of high LDL-C. Lower out-of-pocket costs and simplification of the drug regimen, as well as involvement of nurses, dietitians, health educators, pharmacists and other allied health-care professionals in direct patient care also could be used to improve patient adherence to prescribed regimens.
低密度脂蛋白胆固醇（LDL-C）水平高是冠心病（CHD）的主要危险因素，可以有效治疗。
CDC 分析了 1999-2002 年和 2005-2008 年的数据，以检查美国≥20 岁成年人中 LDL-C 水平高的流行率、治疗和控制情况。这些数值是从参加国家健康和营养检查调查（NHANES）的人血液样本中确定的，NHANES 是一项具有全国代表性的横断面、分层、多阶段概率抽样调查，调查对象为美国的非住院平民人口。国家胆固醇教育计划成人治疗专家组-III 指南将 LDL-C 目标水平设定为<100mg/dL、<130mg/dL 和<160mg/dL，分别用于未来 10 年内发生 CHD 风险高、中、低的人群。LDL-C 水平高的人要么是 LDL-C 水平高于 LDL-C 目标水平的人，要么是报告目前正在服用降胆固醇药物的人。控制 LDL-C 高是指治疗后 LDL-C 值低于目标水平。
根据 2005-2008 年 NHANES 的数据，估计有 7100 万（33.5%）美国≥20 岁成年人 LDL-C 水平高，但只有 3400 万（48.1%）接受了治疗，2300 万（33.2%）得到了控制。在未控制 LDL-C 的人群中，82.8%的人报告有某种形式的医疗保险。1999-2002 年至 2005-2008 年期间，患有 LDL-C 高的成年人接受治疗的比例从 28.4%增加到 48.1%。在 LDL-C 水平高的成年人中，LDL-C 控制的流行率从 14.6%增加到 33.2%。在过去一年接受医疗护理次数少于两次的人群（11.7%）、没有医疗保险的人群（13.5%）、墨西哥裔美国人（20.3%）或收入低于贫困线的人群（21.9%）中，LDL-C 控制的流行率最低。
尽管美国 LDL-C 控制水平有所改善，但仍处于较低水平，尤其是在低收入成年人和医疗保健服务获取有限的人群中。通过改善医疗保健的可及性和医疗质量来加强预防性服务的使用，有望帮助美国更好地控制 LDL-C 水平。
为了提高 LDL-C 控制水平，需要采取综合方法，包括改善临床护理以及提高医疗保健的可及性、可持续性和可负担性。一个整合了电子病历、登记册和医生自动提醒功能的标准化患者护理系统，专注于实现定期患者随访，有可能改善 LDL-C 的控制水平。降低自付费用和简化药物治疗方案，以及让护士、营养师、健康教育工作者、药剂师和其他专业医疗保健人员直接参与患者护理，也可以帮助提高患者对规定治疗方案的依从性。
