Updated U.S. Cholesterol Goals Appear Hard to Reach and Not Being Met

Recent optional goals set by the National Cholesterol Educational Program (NCEP) for low density lipoprotein cholesterol (LDL-C) are not being met by many millions of Americans.

Lead investigator Dr. Stephen D. Persell, stated that, "To reap the benefits we know are possible, "many more people with intermediate or high risk of heart disease will need to adopt lifestyle changes and use medication to reduce their cholesterol."
Dr. Persell of Northwestern University, Chicago and colleagues came to this conclusion after a study using 1999 to 2002 data from more than 3200 participants in the National Health and Nutritional Examination Survey.

In all, 30% had LDL-C levels beyond those recommended by the NCEP in 2001. For the revised optional 2004 goals, the corresponding proportion was 35.8%.

For example, in moderate cardiovascular risk patients the goal was below 130 mg/dL in 2001. In 2004, this goal had fallen to an optional 100 mg/dL in these patients.

The researchers estimated that 24.9 million people exceeded 2001 thresholds for drug therapy and 46.2 million exceeded optional 2001 thresholds for drug therapy. For 2004 optional thresholds, the corresponding figure was 56.5 million.
With changing targets, Dr. Persell said in a statement, "the gap between what we believe to be ideal goals and what has been achieved gets even wider."

This appears to be particularly true of those at moderately high or high risk of cardiovascular disease. Optional 2001 goals for drug therapy were exceeded by 55.8% of those at moderately high risk and 71.8% of people at high risk. Using the revised 2004 standards, the proportions were 87.4% and 96.0%.

"So, many people have excessive risk that could be reduced by lowering the level of ‘bad’ cholesterol," Dr. Persell said.
However, the researchers point out that significant numbers are unlikely to achieve optimal NCEP LDL-C goals with standard-dose statins. Furthermore, the investigators conclude, "Current costs of these drugs may place them out of reach for many patients likely to benefit."
J Gen Intern Med 2006.