Related Experiment Video
Updated: Oct 26, 2025
Differential Effects of Lipid-lowering Drugs in Modulating Morphology of Cholesterol Particles
Published on: November 10, 2017
Prevalence, treatment, and control of severe hyperlipidemia
Matthew E Gold1, Michael G Nanna2, Shannon M Doerfler2
1Duke University School of Medicine, Durham, NC, USA.
Insights
Approximately 3% of US adults have very high LDL-C (≥190 mg/dL). Despite this, follow-up testing and treatment are low, with only about a quarter achieving guideline goals.
Area of Science:
- Cardiology
- Public Health
- Clinical Practice
Background:
- Elevated low-density lipoprotein cholesterol (LDL-C) ≥190 mg/dL is a significant risk factor for atherosclerotic cardiovascular disease.
- Contemporary clinical practices for managing individuals with very high LDL-C require further investigation.
Purpose of the Study:
- To determine the prevalence of LDL-C ≥190 mg/dL in a large adult population.
- To assess the treatment patterns and LDL-C control rates in these individuals.
- To identify factors associated with achieving LDL-C control.
Main Methods:
- Retrospective analysis of electronic health records from Cerner HealthFacts (2000-2017) and Duke University Health System (2015-2017).
- Inclusion criteria: adults (≥18 years) with LDL-C ≥190 mg/dL.
- Multivariable logistic regression was used to evaluate factors associated with LDL-C control.
Main Results:
- The prevalence of LDL-C ≥190 mg/dL was approximately 3% in both datasets.
- Rates of repeat LDL-C measurement within 13 months were low (27.9% in Cerner, 54.5% at DUHS).
- Among those retested, only 18.3%-28.4% achieved LDL-C <100 mg/dL, and 2.7%-4.4% achieved <70 mg/dL. High-intensity statin use was suboptimal (28.5% at DUHS).
- Seeing a cardiologist and having diabetes were associated with increased odds of LDL-C control.
Conclusions:
- A significant proportion of US adults present with very high LDL-C levels.
- Current follow-up and treatment rates for these individuals are insufficient to meet guideline-recommended goals.
- Interventions targeting improved monitoring and treatment intensification are warranted.
Objective:
To identify the prevalence, treatment, and low-density lipoprotein cholesterol (LDL-C) control of individuals with LDL-C ≥190 mg/dL in contemporary clinical practice.
Methods:
We included adults (age ≥18 years) with LDL-C ≥190 mg/dL, at least one LDL-C level drawn from 255 health systems participating in Cerner HealthFacts database (2000-2017, n = 4,623,851), and a detailed examination within Duke University Health System (DUHS, 2015-2017, n = 267,710). Factors associated with LDL-C control were evaluated using multivariable logistic regression modeling.
Results:
The cross-sectional prevalence of LDL-C ≥190 mg/dL was 3.0% in Cerner (n = 139,539/4,623,851) and 2.9% at DUHS (n = 7728/267,710); among these, rates of repeat LDL-C measurement within 13 months were low: 27.9% (n = 38,960) in Cerner, 54.5% (n = 4211) at DUHS. Of patients with follow-up LDL-C levels, 23.6% in Cerner had a 50% of greater reduction in LDL-C, 18.3% achieved an LDL-C <100 mg/dL and 2.7% < 70 mg/dL. At DUHS, 28.4% had a 50% or greater reduction in LDL-C, 28.4% achieved an LDL-C ≤100 mg/dL and 4.4% achieved <70 mg/dL. Within DUHS, 71.6% with LDL-C ≥190 mg/dL were on any statin during follow-up, but only 28.5% were on a high-intensity statin. In multivariable modeling, seeing a cardiologist (Cerner odds ratio [OR] 1.56, confidence interval [CI] 1.33-1.83; DUHS OR 1.89, 95% CI 1.18-3.01) and having diabetes (Cerner OR 1.34 CI 1.23-1.46; DUHS OR 2.07, CI 1.62-2.65) increased odds of LDL-C control, defined as a ≥50% reduction in LDL-C (at Cerner) or initiation of high intensity statin (at DUHS). Prior atherosclerotic cardiovascular disease (OR 1.19, CI 1.07-1.33), hypertension (OR 1.10, CI 1.03-1.18), African American race (OR 0.79, CI 0.71-0.89), and government (vs. private) insurance (OR 0.90, CI 0.83-0.98) were associated with LDL-C control at Cerner. Female sex was associated with lower odds of appropriate therapy (OR 0.69, CI 0.59-0.81) at DUHS.
Conclusions:
Approximately 3% of United States adults have LDL-C ≥190 mg/dL. Among those with very high LDL-C, rates of repeat measurement within one year were low; of those retested, only about one-fourth met guideline-recommended LDL-C treatment goals.
Related Concept Videos
01:20Lipid-Lowering Drugs: Statins and Miscellaneous Agents
01:26Atherosclerosis III: Management
01:26Coronary Artery Disease IV: Preventive Measures
01:15Diabetes: Management and Pharmacotherapy
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
01:26Angina IV: Management
01:28Hypertension IV: Drug Therapy and Lifestyle Modifications