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An Update Based on Guidelines From the Second Report of the National Cholesterol Education Program Adult Treatment Panel

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

JAMA. 1993;269(23):3009-3014.

Abstract
Objective.
—To estimate the current levels and trends in the proportion of US adults with high blood cholesterol based on guidelines from the second report of the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP II).

Design.
—Nationally representative cross-sectional surveys.

Setting/Participants.
—Data for 7775 participants 20 years of age and older from phase 1 of the third National Health and Nutrition Examination Survey (NHANES III) (data collected from 1988 through 1991) and for 9797 participants 20 through 74 years of age from NHANES II (data collected from 1976 through 1980) were used.

Results.
—From the data collection period in NHANES II (1976 through 1980) to the period in NHANES III (1988 through 1991), the proportion of adults with high blood cholesterol levels (240 mg/dL [6.21 mmol/L]) fell from 26% to 20%, while the proportion with desirable levels (<200 mg/dL [5.17 mmol/L]) rose from 44% to 49%. Currently, using the ATP II guidelines and NHANES III data, 40% of all adults 20 years of age and older would require fasting lipoprotein analysis; and 29% of all adults would be candidates for dietary therapy (as compared with 36%, using NHANES II data). Based on 1990 population data, it is estimated that approximately 52 million Americans 20 years of age and older would be candidates for dietary therapy. Assuming that dietary intervention would reduce low-density lipoprotein (LDL) cholesterol levels by 10%, as many as 7% of all adult Americans (approximately 12.7 million) might be candidates for cholesterol-lowering drugs. This estimate reflects approximately 4 million adults with established coronary heart disease, of whom half are aged 65 years and older, and up to 8.7 million adults without established coronary heart disease, of whom up to 3.1 million are aged 65 years and older.

Conclusions.
—Substantial progress has been made in reducing the prevalence of high blood cholesterol; yet a large proportion of all adults, approximately 29%, require dietary intervention for high blood cholesterol.

(JAMA. 1993;269:3009-3014)

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

Footnotes
Reprint requests to the 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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