More Than Half of US Young Adults Saw Elevated LDL-C Levels Over 5-Year Period

According to new findings, more than 50% of young adults in the United States had low-density lipoprotein cholesterol (LDL-C) at least 100 mg/dL in 2015 to 2020, suggesting a rising lifetime risk of cardiovascular disease.

Specifically, data show the mean LDL-C level among US young adults was 104.9 mg/dL in 2015 to 2020.

“These findings may help guide prevention efforts,” added study author Yiyi Zhang, PhD, Division of General Medicine, Columbia University Medical Center.

Zhang and colleagues aimed to characterize the distribution of LDL-C and the prevalence of screening and awareness of high cholesterol among US young adults. To do so, they analyzed National Health and Nutrition Examination Surveys 2003 to 2020 data.

The analysis included young adults, aged 20 to 39 years, with LDL-C measurements. They collected information on age, sex, race and ethnicity, health insurance, and routine place to go for health care based on participant self-report. Measurements of LDL-C were calculated from measured total cholesterol, triglycerides, and high-density lipoprotein cholesterol using the Martin-Hopkins equation.

The awareness of high cholesterol was defined by participant self-report based on physician diagnosis and cholesterol screening was defined based on self-report of having cholesterol checked in the last 5 years.

Data were pooled into 6-year periods and estimated the distribution of LDL-C levels from 2015 through 2020 among all US young adults and in subgroups. Investigators calculated age-adjusted prevalence of LDL-C levels at least 100 mg/dL, at least 130 mg/dL, and at least 160 mg/dL. They evaluated linear trends in logistic regression models and examined cholesterol screening and awareness factors using logistic regression.

The study included a total of 6838 young adults with a mean age of 29.4 years. By demographics, 3623 (50%) were female and 2591 (59%) were non-Hispanic White.

Data show an estimated 51.7% (95% CI, 48.7% - 54.7%) of US young adults had LDL-C level at least 100 mg/dL, 19.7% (95% CI, 17.4% - 22.0%) had LDL-C level at least 130 mg/dL, and 6.1% (95% CI, 4.5% - 7.6%) had LDL-C level at least 160 mg/dL.

Moreover, an estimated 44.3 million (95% CI, 41.7 - 46.9) had LDL-C level at least 100 mg/dL, 16.9 million (95% CI, 14.9 - 16.9) an LDL-C level at least 130 mg/dL, and 5.2 million (95% CI, 3.8 - 6.5) an LDL-C level at least 160 mg/dL.

Investigators noted the age-adjusted prevalence of the 3 studied LDL-C levels decreased between 2003 and 2008 and 2015 and 2020.

Among individuals with LDL-C at least 130 mg/dL, 20.6% were aware of having high cholesterol in 2003 to 2006; 19.2% in 2009 to 2014; and 23.3% in 2015 to 2020 (P = .58 for trend).

Each period saw 41.0% to 41.9% get their cholesterol checked within the last 5 years (P = .51 for trend).

Investigators added that younger age, male sex, lack of insurance, and lack of routine to go for health care were associated with a lower likelihood of cholesterol screening. Additionally, younger age and lack of insurance or routine place for health care were also associated with lower awareness of high cholesterol.

The research letter, “Trends of Elevated Low-Density Lipoprotein Cholesterol, Awareness, and Screening Among Young Adults in the US, 2003-2020,” was published in JAMA Cardiology.