• Research Review
• Journal Review

Authors: U Upadhyay, E Needham, S Young, B Kerker, et al.

Reference: Preventing Chronic Disease 2010; 7(3)
http://www.cdc.gov/pcd/issues/2010/May/09_0196.htm

Reviewer: Carlos Mendoza Montano, PhD, ProCor contributing editor; President, Guatemalan Association for the Prevention of Heart Diseases (APRECOR), Guatemala City, Guatemala

Reviewer comments: Despite advances in lowering total blood cholesterol, control of lipid levels remains poor in the United States. Local monitoring of the prevalence, treatment, and control of coronary heart disease (CHD) risk factors is needed for planning and evaluating interventions to prevent CHD. This study documents the large burden of high LDL cholesterol in New York City. The study also found that nearly one-third of adults with high LDL cholesterol were unaware of their condition. Among those who were aware, less than two-thirds were taking cholesterol-lowering medications and less than half had their LDL cholesterol under control, suggesting that adults in New York City are not adequately treated. On a broader level, programs that address primary prevention of high cholesterol through changes in the food environment and tobacco policies can prevent CHD-related illness and death and reduce health disparities.

Purpose of study: To estimate the prevalence, awareness, treatment, and control of high LDL cholesterol in diverse populations of New York City.

Location of study: New York City, New York

Study design: NYC HANES is a population-based, cross-sectional, examination survey of non-institutionalized New York City adult residents aged 20 years or older. A 3-stage cluster sampling design was used to recruit participants from June through December 2,004. The National Health and Nutrition Examination Survey 2003-2004 was used for comparison. High LDL cholesterol and CHD risk were defined using National Cholesterol Education Program Adult Treatment Panel III (ATP III) guidelines.

Results: Mean total cholesterol was significantly lower in New York City (197.7 mg/dl) than in the United States overall (203.0 mg/dl). No difference was seen in mean LDL cholesterol overall, but New York City foreign-born adults had higher mean LDL cholesterol than US foreign-born adults (122.5 vs 117.8). In New York City, 28% of adults had high LDL cholesterol, 71% of whom were aware of their condition. Most aware adults reported modifying their diet or activity level (88%), 64% took medication, and 44% had their condition under control. More aware adults in the low ATP III risk group than those in higher risk groups had controlled LDL cholesterol (71% vs 33%-42%); more whites than blacks and Hispanics had controlled LDL cholesterol (53% vs 31% and 32%, respectively).

Additional References:
A Hyre, P Muntner, A Menke, P Raggi, J He. Trends in ATP III-defined high blood cholesterol prevalence, awareness, treatment and control among US adults. Ann Epidemiol 2007; 17(7):548-55. http://www.ncbi.nlm.nih.gov/pubmed/17395483

S Angell, R Garg, R Gwynn, L Bash, L Thorpe, T Frieden. Prevalence, awareness, treatment, and predictors of control of hypertension in New York City. Circ Cardiovasc Qual Outcomes 2008; 1(1):46-53. http://www.ncbi.nlm.nih.gov/pubmed/20031787?