Prevalence of elevated serum cholesterol in personnel of the U.S. Navy

Fasting blood lipid profiles were collected for 5,487 active duty Navy men and women presenting for routine physical examinations. Mean serum cholesterol for the sample (mean age 33.6 years) was 208.2 milligrams per deciliter (mg per dL). Cholesterol level increased with age, decreased with education, and was higher in men than in women. Using the Navy's own risk cutpoints for total cholesterol (200 mg per dL for ages 18-24, 220 mg per dL for ages 25 and older), 36.9 percent of the sample were found to be at risk. When the percentage of the population at risk was computed using the guidelines suggested by the National Institutes of Health Consensus Conference, rather than the Navy's cutpoints, results were almost identical (36.3 percent at risk); when based on the National Cholesterol Education Program's recommended cutpoints, the percent at risk was considerably higher (55.4 percent). Risk estimates that included LDL- or HDL-cholesterol risk levels (or both) also were higher. A larger percentage of Navy personnel were at risk because of total cholesterol than were persons in an age-adjusted national sample. However, because routine examinations generally are not given until first reenlistment, the Navy sample underrepresented younger service members, and results may overestimate the prevalence of hypercholesterolemia in the Navy at large. The author draws attention to the problem of lack of standardization in cholesterol testing and notes that the Navy does not yet participate in an external quality control program. The difficulty in setting appropriate risk cutpoints, given the complexity of factors that must be considered as well as the general unreliability of cholesterol tests, is also discussed.