Prevalence of blood cholesterol screening, elevated levels, and medication use among adults – United States, 2019-2023

Abstract

Background/Synopsis

Elevated levels of total blood cholesterol are associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD). Blood cholesterol levels increase with age, and disparities exist across sociodemographic characteristics. Clinical guidelines and recommendations encourage regular screening and management of blood cholesterol to reduce the risks of ASCVD in adults.

Objective/Purpose

This study assessed recent national and state-level trends in the age-standardized prevalence of self-reported blood cholesterol screening, high blood cholesterol, and medication use among United States (US) adults aged ≥ 18 years using data from the 2019-2023 Behavioral Risk Factor Surveillance System (BRFSS).

Methods

BRFSS is a system of health-related telephone surveys conducted among non-institutionalized US adults. Age-standardized prevalence of blood cholesterol screening during the preceding 5 years, high blood cholesterol among those who had ever screened, and medication use were assessed by sex, age group, race and ethnicity, educational attainment, and state of residence, including the District of Columbia. All percentages were age-stratified or age-standardized using the 2000 US census. The absolute (percentage point) and relative (percent) changes from 2019 to 2023 were calculated, and linear trends across survey periods were assessed using orthogonal polynomial coefficients. This analysis used SAS-callable SUDAAN to account for complex sampling design and weighting.

Results

After excluding respondents with missing cholesterol or sociodemographic data, the final analytic samples for 2019, 2021, and 2023 were 371,144, 385,954, and 383,892, respectively. From 2019 to 2023, there was a slight decrease in the prevalence of adults who reported of having blood cholesterol screened during the preceding 5 years, decreasing by 0.5% from 86.0% to 85.6% (-0.4 percentage points, p = 0.026). Among adults who had ever screened, the prevalence of high blood cholesterol increased by 13.7%, rising from 29.2% to 33.2% (4.0 percentage points, p < 0.001). Among adults told to have high blood cholesterol, the prevalence of medication use remained at approximately 41.5%. The prevalence of screening, awareness, and medication use for high blood cholesterol varied by sociodemographic characteristics and state of residence. Notably, 34 US states experienced a significant increase in the prevalence of high blood cholesterol.

Conclusions

This analysis highlights the population-level disparities in screening, awareness, and treatment for high blood cholesterol. To achieve the Healthy People 2030 goals of reducing blood cholesterol and increasing treatment in US adults with high blood cholesterol, clinicians, policymakers, and public health practitioners should consider interventions that enhance awareness about the importance of early detection and appropriate treatment, specifically for disproportionately affected populations.