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The National Health and Nutrition Examination Surveys

Clifford L. Johnson, MSPH; Basil M. Rifkind, MD; Christopher T. Sempos, PhD; Margaret D. Carroll, MSPH; Paul S. Bachorik, PhD; Ronette R. Briefel, DrPH, RD; David J. Gordon, MD, PhD; Vicki L. Burt, ScM, RN; Clarice D. Brown, MS; Kenneth Lippel, PhD; James I. Cleeman, MD

JAMA. 1993;269(23):3002-3008.

Abstract
Objective.
—To examine the secular trend in serum total cholesterol levels of the US adult population.

Design.
—Nationally representative cross-sectional surveys with both an inperson interview and a medical examination that included the measurement of blood lipid levels.

Setting/Participants.
—Between 6000 and 13000 adults aged 20 through 74 years examined in each of four separate national surveys during 1960 through 1962, 1971 through 1974, 1976 through 1980, and 1988 through 1991.

Results.
—Mean serum total cholesterol levels in US adults aged 20 through 74 years have consistently declined over the time period 1960 through 1991. More than half of the decline occurred during the time period 1976 through 1991. This decline occurred across the entire distribution of serum cholesterol levels and in all age-sex groups. High-density lipoprotein cholesterol and very low-density lipoprotein cholesterol levels have not changed, suggesting that the decline in total cholesterol levels is due to a decline in low-density lipoprotein cholesterol levels.

Conclusions.
—These results document a continuing and substantial decline in serum cholesterol levels among US adults. They suggest that public health programs, designed to reduce cholesterol levels, are proving successful. The observed downward trend in serum cholesterol levels has coincided with a continuing decline in coronary heart disease mortality. These observations suggest that the Healthy People 2000 goal of reducing the mean serum cholesterol level of US adults to no more than 200 mg/dL (5.17 mmol/L) is attainable.

(JAMA. 1993;269:3002-3008)

Author Affiliations
From the Division of Health Examination Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Md (Mr Johnson, Drs Sempos and Briefel, and Mss Carroll and Burt); National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (Drs Rifkind, Gordon, Lippel, and Cleeman, and Ms Brown); and The Johns Hopkins Hospital, The Children's Medical and Surgical Center, Baltimore, Md (Dr Bachorik).

Footnotes
Reprint requests to National Cholesterol Education Program, National Heart, Lung, and Blood Institute, National Institutes of Health, Bldg 31, Room 4A-05, Bethesda, MD 20892 (Dr Cleeman).

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