Favorable Trends for Lipid Levels in US Youths From 1999 to 2016

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).

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.