Favorable temporal trends were observed for lipid levels in youths in the United States, according to study results published in JAMA.

In this serial cross-sectional analysis, researchers used data from the National Health and Nutrition Examination Survey to examine trends in high-density lipoprotein (HDL) cholesterol and total cholesterol levels in youths aged 6 to 19 years (N = 26,047). Changes in fasting triglycerides and apolipoprotein B were also examined in a subset of adolescents aged 12 to 19 years. The researchers used data from 9 consecutive survey cycles from 1999 to 2000 through 2015 to 2016.

Ideal and averse cutoff points for levels of lipids and apolipoprotein B were, respectively, <170 mg/dL and ≥200 mg/dL for total cholesterol, >45 mg/dL and <40 mg/dL for HDL cholesterol, <120 mg/dL and ≥145 mg/dL for non-HDL cholesterol, <90 mg/dL and ≥130 mg/dL for triglycerides, <110 mg/dL and ≥130 mg/dL for low-density lipoprotein (LDL) cholesterol, and <90 mg/dL and ≥110 mg/dL for apolipoprotein B.

Over the 18-year study period, the mean total cholesterol level decreased linearly from 164 mg/dL (95% CI, 161-167 mg/dL) in 1999 to 2000 to 155 mg/dL (95% CI, 154-157 mg/dL) in 2015 to 2016 (β for linear trend, -0.6 mg/dL per year) after adjustments for age and race/ethnicity.

Other major findings included the following:

  •  Adjusted mean HDL cholesterol level increased from 52.5 mg/dL (95% CI, 51.7-53.3 mg/dL) in 2007 to 2008 to 55.0 mg/dL (95% CI, 53.8-56.3 mg/dL) in 2015 to 2016 (β, 0.2 mg/dL per year).
  •  Adjusted mean non-HDL cholesterol level decreased from 108 mg/dL (95% CI, 106-110 mg/dL) in 2007 to 2008 to 100 mg/dL (95% CI, 99-102 mg/dL) in 2015 to 2016 (β, -0.9 mg/dL per year).
  • In adolescents, the adjusted geometric mean for triglycerides declined from 78 mg/dL (95% CI, 74-82 mg/dL) in 1999 to 2000 to 63 mg/dL (95% CI, 58-68 mg/dL) in 2013 to 2014, which represented a mean decrease of 1.5% every year (log-transformed β, -0.015 per year).
  • Adjusted mean LDL cholesterol level decreased from 92 mg/dL (95% CI, 89-95 mg/dL) in 1999 to 2000 to 86 mg/dL (95% CI, 83-90 mg/dL) in 2013 to 2014 (β, -0.4 mg/dL per year).
  • Adjusted mean apolipoprotein B level declined from 70 mg/dL (95% CI, 68-72 mg/dL) in 2005 to 2006 to 67 mg/dL (95% CI, 65-70 mg/dL) in 2013 to 2014 (β, -0.4 mg/dL per year).
  •  Adjusted mean apolipoprotein B level declined from 70 mg/dL (95% CI, 68-72 mg/dL) in 2005 to 2006 to 67 mg/dL (95% CI, 65-70 mg/dL) in 2013 to 2014 (β, -0.4 mg/dL per year).

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Despite finding these favorable trends, the researchers noted that 19% to 25% of youths in the study had ≥1 adverse level. Overall, 47% to 51% had ideal levels for all lipids at the end of the study.

The study was limited by the fact that study periods for HDL cholesterol, non-HDL cholesterol, and apolipoprotein B were truncated because of potential bias or data unavailability during certain survey cycles. Youths using lipid-lowering medications were also not excluded from participating in the study. In addition, pubertal staging was unavailable, despite its importance for lipid profiles for young patients.

The investigators demonstrated a continuation of favorable trends in mean lipid levels in pediatric patients in the US, which warrants some optimism about the future of atherosclerotic cardiovascular disease related to dyslipidemia.

Disclosure: One author declared affiliation with NGM Biopharmaceuticals.

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Reference

Perak AM, Ning H, Kit BK, et al. Trends in levels of lipids and apolipoprotein B in US youths aged 6 to 19 years, 1999-2016. JAMA. 2019;321(19):1895-1905.