National Trends in Lipid Levels in the United States from 2000 to 2023 Using the Epic Cosmos Database

National tracking of lipid levels is valuable for informing policy and guidelines for improving population health, but current national surveillance systems are hindered by poor data timeliness and small sample sizes among racial/ethnic minorities.

The study's primary objective was to describe temporal trends in lipid levels and control in the United States from 2000 to 2023.

The current study incorporated Epic Cosmos-a research database aggregated from the electronic health record data of >250 U.S. health systems. Five lipid parameters (total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol [HDL-C], non-HDL-C, triglycerides) were analyzed. Age- and sex-standardized means were calculated both overall and across 7 racial/ethnic groups.

This study included 63,600,730 unique individuals contributing >175 million results per lipid parameter. All lipid parameters generally improved over time though improvements were larger earlier in the study period. For example, in years 2003, 2013, and 2023, age-standardized mean low-density lipoprotein cholesterol among males was 116.5, 104.1, and 102.1 mg/dL, and among females, 117.8, 106.1, and 105.3 mg/dL. Racial/ethnic disparities were observed across all lipid parameters. For instance, in 2023, mean triglycerides varied up to 41.2 mg/dL across racial/ethnic groups, being highest among Hispanic (144.2 mg/dL) and lowest among Black individuals (103.0 mg/dL). All lipid parameters except HDL-C worsened during the COVID-19 era, disproportionately affecting racial/ethnic minorities.

This study provides a contemporary, real-world, population-level assessment of lipid control and disparities in the United States, providing the first national data on these issues since the COVID-19 pandemic and release of updated cholesterol guidelines.