Research ObjectivesThe LDL/HDL cholesterol ratio is a biomarker of the risk of coronary heart disease. This study aimed to examine the trends and differences in serum low-density lipoprotein cholesterol-to-high density lipoprotein cholesterol (LDL/HDL-C) ratio among U.S. residents by survey years, selected demographic, and socioeconomic variables.DesignThis is an observational study.SettingGeneral community.ParticipantsBlood lipid measurements, taken from 21,850 noninstitutionalized participants, aged 6 to 80, were obtained from the National Health and Nutrition Examination Survey (NHANES) study. We described the distributions of LDL/HDL-C ratio across the life span in four distinct cross-sectional surveys during 2005-2008, 2009-2012, 2013-2016, and 2017-2020, and compared the ratio levels by race/ethnicity, education level, ratio of income to poverty, body mass index (BMI), and general health condition.InterventionsN/A.Main Outcome MeasuresBlood lipid measurements.ResultsThe LDL/HDL-C ratio levels varied by sex and age. Between 2005 and 2020, favorable trends in lipid ratio levels were observed. Overall, non-Hispanic black individuals tended to have lower mean LDL/HDL-C ratio levels than other groups, while Mexican American and other Hispanic individuals tended to have higher LDL/HDL-C ratio levels on average. Being male, having a lower educational level, being obese or having a higher BMI, and reporting poor or fair health status were associated with higher LDL/HDL-C ratio levels. In females, income lower than the poverty level was associated with higher LDL/HDL-C levels. However, there was no difference in LDL/HDL-C levels in males by poverty level.ConclusionsBetween 2005 and 2020, favorable trends in LDL/HDL-C values were observed among noninstitutionalized residents in the US. Targeted educational efforts are warranted to enhance knowledge of personal risk indicators.Author(s) DisclosuresThe authors declare no conflict of interest.

Objective Low-density lipoprotein-cholesterol (LDL-C) remains a clinically important cholesterol target in primary prevention of atherosclerotic cardiovascular disease. The present study aimed to assess the practical differences among three equations utilized for the estimation of LDL-C: the Friedewald, the Martin/Hopkins, and the NIH equation 2. Methods Blood lipid measurements from 4,556 noninstitutionalized participants, aged 12 to 80, were obtained from the 2017-2020 National Health and Nutrition Examination Survey study. We 1) assessed the differences between three calculated LDL-C estimates, 2) examined the correlations between LDL-C estimates using correlation coefficients and regression, and 3) investigated the degree of agreement in classifying individuals into the LDL-C category using weighted Kappa and percentage of agreement. Results The differences in LDL-C estimates between equations varied by sex and triglyceride levels (p<0.001). Overall, the mean of absolute differences between Friedewald and Martin/Hopkins was 3.17 mg/dL (median=2.0, 95% confidence interval [CI] [3.07–3.27]). The mean of absolute differences between Friedewald and NIH Equation 2 was 2.08 mg/dL (median=2.0, 95% CI [2.03–2.14]). Friedewald correlated highly with Martin/Hopkins (r=0.991, rho=0.989) and NIH Equation 2 (r=0.998, rho=0.997). Cohen’s weighted Kappa=0.92 between Friedewald and Martin/Hopkins, and 0.95 between Friedewald and NIH equation 2. The percentage of agreement in classifying individuals into the same LDL-C category was 93.0% between Friedewald and Martin/Hopkins, and 95.4% between Friedewald and NIH equation 2. Conclusion Understanding the practical differences in LDL-C calculations can be helpful in facilitating decision-making during a paradigm shift.

Background: Elevated levels of low-density lipoprotein cholesterol (LDL-C) are associated with an increased risk of coronary heart disease. Objectives: We described LDL-C distributions across the age span and compared the trends in three distinct cross-sectional surveys during 2007-2010, 2011-2014, and 2015-2018. Methods: This is an observational study. Blood lipid measurements, taken from 40,977 noninstitutionalized participants, aged 12 to 80, were obtained from the National Health and Nutrition Examination Survey (NHANES) study. Results: The LDL-C values changed by age and differed by sex. Mean LDL-C levels increased with age through middle age and then decreased with age. In males, mean LDL-C declined from 104.5 (95% CI, 103.6-105.3) in 2007-2010, to 100.5 (95% CI, 99.7-101.4) in 2011-2014, and 100.8 (95% CI, 99.9-101.7) in 2015-2018 (p<0.001 for linear trend). In females, mean LDL-C declined from 110.3 (95% CI, 109.5-111.1) in 2007-2010, to 108.3 (95% CI, 107.6-109.1) in 2011-2014, and 106.8 (95% CI, 105.9-107.7) in 2015-2018 (p<0.001 for linear trend). Conclusions: Between 2007 and 2018, favorable trends in LDL-C levels were observed among noninstitutionalized residents in the US.

Background. Cholesterol levels in total cholesterol (TC), low-density lipoprotein (LDL-C), high-density lipoprotein (HDL-C), and triglyceride (TG) contribute to atherosclerosis and its clinical consequences. Objectives. This study aimed to examine the trends in serum TC/HDL and LDL/HDL ratio across the age span. Methods. This is an observational study. Blood lipid measurements, taken from 85,646 noninstitutionalized participants, aged 6 to 80, were obtained from the National Health and Nutrition Examination Survey (NHANES) study. We compared the TC/HDL and LDL/HDL ratio trends in three distinct cross-sectional surveys during 2007-2010, 2011-2014, and 2015- 2018. Results. Cholesterol ratios changed by age and differed by sex. Mean TC/HDL ratios declined from 4.03 (95% CI, 4.01-4.05) in 2007-2010, to 3.84 (95% CI, 3.81-3.87) in 2015-2018 (p<.05 for linear trend) in male; mean TC/HDL ratios declined from 3.69 (95% CI, 3.67-3.70) in 2007- 2010, to 3.45 (95% CI, 3.42-3.47) in 2015-2018 (p<.05 for linear trend) in female. Mean LDL/HDL ratios declined from 2.30 (95% CI, 2.28-2.32) in 2007-2010, to 2.18 (95% CI, 2.15- 2.20) in 2015-2018 (p<.05 for linear trend) in male; mean LDL/HDL ratios declined from 2.04 (95% CI, 2.02-2.06) in 2007-2010, to 1.96 (95% CI, 1.94-1.98) in 2015-2018 (p<.001 for linear trend) in female. Conclusions. Between 2007 and 2018, favorable trends in lipid ratio levels were observed among noninstitutionalized residents in the US.