Trends in Serum Lipids and Lipoproteins of Adults, 1960-2002

Abstract

NUMBER OF EPIDEMIOLOGICALstudies have investigated the association between lipids and atherosclerotic disease. The Framingham Heart Study 1 has assessed longitudinal trends in lipid levels and their association with atherosclerotic disease, with data collection beginning in 1948. Examples of other longitudinal studies in the United States are the Atherosclerosis Risk in Communities study, 2 the Cardiovascular Heart Study, 3 the Coronary Artery Risk Development in Young Adults study, 4 and the Multi-Ethnic Study of Atherosclerosis. 5 The Multinational Monitoring of Trends and Determinants in Cardiovascular Disease study 6 is an international study of adults aged 35 to 64 years in 21 countries on 4 continents. In this study, total cholesterol levels of adults aged 35 to 64 years showed a decline in mean serum total cholesterol from the mid-1980s to the mid-1990s in approximately half of the European populations included in the study. 7 The National Health Examination Survey (NHES) and the National Health and Nutrition Examination Surveys (NHANES) conducted by the National Center for Health Statistics/ Centers for Disease Control and Prevention (NCHS/CDC) are unique among US studies. In NHANES, a wide battery of health-related data, including serum lipids, were collected from a representative sample of the US civilian noninstitutionalized popula-tion in standardized examinations. Through these surveys, the NCHS/ CDC has been obtaining population estimates of serum total cholesterol since 1960 and high-density lipoprotein

Trends in blood lipids and fat soluble vitamins in Catalonia, Spain (1992–2003)

“…As reported in other publications, although these countries have a high prevalence of cardiovascular risk factors 41 , the morbidity and mortality related to cardiovascular diseases are lower than other European countries 42 . In Catalonia, as shown in other countries, TC increased with age group 35,43,44 and females had better lipid profiles than males 44,56 .…”

“…On the contrary, in other countries such as the USA 35 , Japan 46 and Finland 48 , data show that lipid levels of TG increased together with the prevalence of overweight and obesity. Moderation in alcoholic beverage consumption has been reported in Catalonia 49 .…”

“…On the other hand, a decrease in TC, LDL and TG levels, a trend that had already been previously reported for the 1980-1992 decade 30 , counteracts the main findings seen. Certain European [31][32][33][34] countries and the USA 35 have shown similar trends, with a decrease in the serum lipid levels but of a different magnitude for each lipoprotein. The analysis of serum lipids conducted in the USA during the same time period also showed a decrease in the levels of TC and LDL and a decrease in the percentage of the population with hypercholesterolaemia, as shown in adults from Catalonia.…”

Interpretation of the evidence for the efficacy and safety of statin therapy

“…175,176 Representative data from population-based studies conducted before evidence of beneficial effects of statin therapy on fatal and nonfatal vascular events emerged from large randomized trials indicate that average LDL cholesterol concentrations in Western populations among people in middle and old age are about 4 mmol/L (or more) in the absence of statin therapy. 177,178 The proportional reductions in LDL cholesterol achieved with statin therapy are not materially affected by the starting LDL cholesterol concentration or by other patient characteristics (such as age, sex, vascular risk, genetic markers). [30][31][32][33]179 Different statins have different potency on a "mmol/L-per-mg" basis, with the newer agents (e.g.…”

“…158 Use of high-intensity statin therapy would be expected to reduce LDL cholesterol by at least 2 mmol/L in individuals who present with concentrations of 4 mmol/L or more (i.e. about half of the population in the absence of statin therapy 177,178 ), but by only about 1 mmol/L in those with concentrations of 2 mmol/L. Consequently, since the proportional reductions in vascular event rates with statin therapy are related to the absolute reductions in LDL cholesterol that are achieved (see below), intensive statin therapy should be focused on patients at higher risk of vascular events rather than just those with high cholesterol concentrations.…”