Department of Family and Community Medicine, University of Illinois School of Medicine, Peoria, IL, USA.
J Clin Lipidol. 2012 Jul-Aug;6(4):325-30. doi: 10.1016/j.jacl.2012.05.002. Epub 2012 May 22.
The association between increased low-density lipoprotein cholesterol (LDL-C) and increased risk for cardiovascular events is well established, with treatment focusing on LDL-C lowering. Other lipid abnormalities are also associated with increased cardiovascular risk (eg, low high-density lipoprotein cholesterol [HDL-C], high triglycerides [TG], and high non-HDL-C). Despite national lipid guidelines, the prevalence of these abnormal lipid parameters alone or in combination (mixed dyslipidemia) is not well recognized.
We assessed the prevalence of high LDL-C, low HDL-C, high TG, high non-HDL-C, and mixed dyslipidemia by using National Health and Nutrition Examination Survey (NHANES) data to estimate the proportions of U.S. adults not at guideline-recommended lipid goals.
NHANES 2003-2006 fasting blood serum data were used to categorize adults aged ≥20 years by LDL-C (risk stratum-specific), HDL-C (men, <40 mg/dL; women, <50 mg/dL), non-HDL-C (in subjects with TG ≥200 mg/dL), and TG (≥150 mg/dL) target levels with use of the NCEP ATP III definitions based on coronary heart disease (CHD) risk.
An estimated 53% (105.3M) of U.S. adults have lipid abnormalities: 27% (53.5M) have high LDL-C, 23% (46.4M) have low HDL-C, and 30% (58.9M) have high TG. Among patients with serum TG levels ≥200 mg/dL, approximately 13% (25.7M) of adults have non-HDL-C levels ≥130 mg/dL. Also, 21% (42.0M) of U.S. adults have mixed dyslipidemia (high LDL-C with either low HDL-C and/or high TG), with nearly 6% (11.6M) having all three lipid abnormalities. For LDL-C, an estimated 23M adults with CHD or a CHD risk equivalent and 17M with ≥2 risk factors but a Framingham risk ≤20% are not at goals of <100 and <130 mg/dL, respectively.
Prevalence of dyslipidemia in the United States continues to be high, with the majority of U.S. adults now affected by some form of lipid abnormality. Efforts to promote screening, risk stratification, and initiating appropriate treatment should be intensified.
已有充分证据表明，低密度脂蛋白胆固醇（LDL-C）升高与心血管事件风险增加有关，因此治疗重点是降低 LDL-C。其他脂质异常也与心血管风险增加相关（例如，高密度脂蛋白胆固醇 [HDL-C] 降低、甘油三酯 [TG] 升高和非高密度脂蛋白胆固醇 [non-HDL-C] 升高）。尽管有国家脂质指南，但这些异常脂质参数单独或联合存在（混合性血脂异常）的流行情况尚未得到充分认识。
我们使用国家健康与营养调查（NHANES）数据评估高 LDL-C、低 HDL-C、高 TG、高 non-HDL-C 和混合性血脂异常的流行情况，以估计不符合指南推荐的血脂目标的美国成年人比例。
使用 2003-2006 年 NHANES 的空腹血清数据，根据 NCEP ATP III 基于冠心病（CHD）风险的定义，根据 LDL-C（风险分层特异性）、HDL-C（男性，<40mg/dL；女性，<50mg/dL）、非-HDL-C（在 TG≥200mg/dL 的患者中）和 TG（≥150mg/dL）靶目标水平对年龄≥20 岁的成年人进行分类。
据估计，53%（105.3M）的美国成年人存在脂质异常：27%（53.5M）存在高 LDL-C，23%（46.4M）存在低 HDL-C，30%（58.9M）存在高 TG。在 TG 水平≥200mg/dL 的患者中，约有 13%（25.7M）成年人的非-HDL-C 水平≥130mg/dL。此外，21%（42.0M）的美国成年人患有混合性血脂异常（高 LDL-C 伴低 HDL-C 和/或高 TG），其中近 6%（11.6M）存在三种脂质异常。对于 LDL-C，据估计，有 23M 患有 CHD 或 CHD 风险等同疾病的成年人和有≥2 个危险因素但 Framingham 风险<20%的 17M 成年人未达到<100 和<130mg/dL 的目标值。
美国的血脂异常患病率仍然很高，大多数美国成年人现在都受到某种形式的脂质异常的影响。应加强促进筛查、风险分层和启动适当治疗的力度。
