High Serum Total Cholesterol – An Indicator for Monitoring 

Cholesterol Lowering Efforts: U.S. Adults, 2005–2006

Susan E. Schober, Ph.D.; Margaret D Carroll, M.S.P.H.; David A. Lacher, M.D.; and Rosemarie Hirsch, M.D., M.P.H.,

Division of Health and Nutrition Examination Surveys

NCHS Data Brief

No. 2 December 2007

Highlights

Data from the

National Health and

Nutrition Examination 

Survey

► Between 1999–2000 and 

2005–2006, mean serum 

total cholesterol levels in 

adults 20 years and older 

declined from 204 mg/dL 

to 199 mg/dL. The decline 

in mean total cholesterol 

was observed for men 

aged 40 years and older 

and for women aged 60 

years and older. There was 

little change over this time 

period for other sex-age 

groups. 

► In 2005–2006, approximately 65% of men and 

70% of women had been 

screened for high cholesterol within the past 5 

years.

► In 2005–2006, 16% 

of adults had serum total 

cholesterol levels of 240 

mg/dL or greater.

► In 2005–2006, approximately 8% of U.S. adults 

had serum total cholesterol 

levels greater than or equal 

to 240 mg/dL but had never 

been told by a health care 

provider that their cholesterol levels were high.

Importance

Elevated serum total cholesterol is a major and modifiable risk factor for heart disease, the leading cause of death in the United States (1,2). Reducing mean total serum cholesterol levels 

among adults to less than 200 mg/dL and reducing the proportion who have levels of 240 mg/dL 

or higher to less than 17% are national Healthy People 2010 objectives (3). Age-adjusted mean 

serum cholesterol levels among adults aged 20–74 years declined from 222 mg/dL in 1960–1962 

to 203 mg/dL in 1999–2002 (4). Among adults aged 20 years and older, the percent of the population with high serum total cholesterol levels (240 mg/dL or higher) declined from 20% during 

1988–1994 to 17% during 1999–2002 (4). In individual patients, a high serum total cholesterol 

level indicates a potential increased risk for heart disease, but further evaluation of other risk 

factors and the specific components of cholesterol provide the basis for determining the need for 

initiating therapeutic lifestyle changes or treatment with medication (5). Low-density-lipoprotein (LDL) is the cholesterol component associated with arterial blockage, and it is the primary 

clinical target for cholesterol management. High-density-lipoprotein (HDL) may help to protect 

individuals from developing heart disease. In populations, comparisons of total cholesterol levels 

over time can show if population groups are experiencing improvement in cholesterol levels, and 

knowledge of trends in levels of total cholesterol can help identify subgroups where additional 

prevention efforts may be needed.

Keywords: cholesterol ● prevalence ● trends

Findings

Have serum total cholesterol levels of U.S. adults declined since 1999?

Figure 1. Mean serum total cholesterol levels of adults aged 20 years and older by age 

and sex, United States, 1999–2006

0

Men

180

190

200

210

220

230

0

180

190

200

210

220

230

60 years and older

60 years and older

40–59 years

40–59 years

20–39 years 20–39 years

2005–2006

2003–2004

2001–2002

1999–2000

2005–2006

2003–2004

2001–2002

1999–2000

Mean total cholesterol (mg/dL)

Mean total cholesterol (mg/dL)

SOURCE: CDC/NCHS, National Health and Nutrition Examination Surveys, 1999–2006.

Women

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics
No. 2 December 2007

NCHS Data Brief 

● Mean serum total cholesterol levels of U.S. adults aged 20 years and older declined from 

204 mg/dL in 1999–2000 to 199 mg/dL in 2005–2006. 

The age-adjusted mean serum total cholesterol level was 199 mg/dL in 2005–2006. Thus, the 

Healthy People 2010 objective to reduce mean serum cholesterol levels among adults to less than 

200 mg/dL was met. 

● Mean serum total cholesterol levels have declined for men aged 40 years and older and for 

women aged 60 years and older over the time period 1999–2006. 

Among men aged 40–59 years, mean serum total cholesterol declined from 214 mg/dL in 

1999–2000 to 205 mg/dL in 2005–2006, a difference of 9 mg/dL. Over the same period of time, 

mean serum total cholesterol levels declined from 206 mg/dL to 189 mg/dL for men aged 60 years 

and older, a difference of 17 mg/dL, and from 224 mg/dL to 209 mg/dL for women aged 60 years 

and older, a difference of 15 mg/dL. There was little change over this time period for other sex/age 

groups. 

● Mean serum total cholesterol levels are similar between men and women aged 20–59 years 

but are significantly higher in women compared with men among those aged 60 years

 and over. 

Serum cholesterol levels varied significantly by age among both men and women; however, the 

pattern of variation was different. Among men in 2005–2006, serum total cholesterol levels were 

highest in those aged 40–59 years and levels were similar for those aged 20–39 years and those 

aged 60 years and older. Among women, serum total cholesterol levels for those aged 20–39 years 

were significantly lower compared with older age groups and were similar for those aged 40–59 

years and those aged 60 years and older. The pattern of higher total cholesterol levels in older 

women as compared with older men has been previously observed (4). The higher total cholesterol 

levels in older women may reflect hormonal changes during and after menopause. In addition, 

HDL levels in women tend to be higher than in men, and this also contributes to their higher total 

cholesterol levels. 

Are U.S. adults receiving recommended screening for high blood cholesterol? 

● In 2005–2006, approximately 65% of men and 70% of women had been screened for high 

cholesterol within the past 5 years. 

The proportion of persons who were screened for high blood cholesterol in the past 5 years increased with age for both men and women. Overall, the prevalence of this recommended screening 

was higher in women than in men, but among those aged 60 years and older, both men and women 

had similarly high rates of screening, approximately 91% and 88%, respectively. Women were 

more likely than men to receive the recommended screening among those aged 20–39 years (52% 

versus 41%, respectively) and among those aged 40–59 years (81% versus 74%, respectively). 

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December 2007

3

No. 2

NCHS Data Brief

Figure 2. Percentage of adults aged 20 years and older who had received screening for 

high blood cholesterol in the past 5 years by age and sex, United States, 2005–2006

Age in years

Percent 1Significant difference from men.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Surveys, 2005–2006.

0

20

40

60

80

100

Men Women

Total 20–39 40–59 60 and older

(1)

(1)

(1)

What proportion of U.S. adults has high serum total cholesterol levels?

● Approximately 16% of U.S. adults have high serum total cholesterol levels.

In 2005–2006, 15.7% of adults 20 years and older had serum cholesterol levels equal to or greater 

than 240 mg/dL. Individuals who take medication to lower their serum cholesterol and whose measured serum total cholesterol levels are less than 240 mg/dL are not defi ned as having high total 

cholesterol in this report.

Figure 3. Prevalence of high serum total cholesterol by age and sex, United States, 

2005–2006

Age in years

Percent 1Significant difference from men.

NOTE: High serum total cholesterol defined by serum total cholesterol 240 mg/dL.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Surveys, 2005–2006.

0

5

10

15

20

25

Men Women

Total 20–39 40–59 60 and older

(1)

(1)
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December 2007

NCHS Data Brief

No. 2

● The prevalence of high serum total cholesterol was higher for women than for men.

In 2005–2006, 13.8% of men aged 20 years and older and 17.3% of women aged 20 years and older 

had serum cholesterol levels that were equal to or greater than 240 mg/dL, a difference that was 

statistically signifi cant. 

The difference between men and women was limited to those aged 60 years and older. In this age 

group, 10.0% of men and 23.0% of women had serum total cholesterol levels equal to or greater 

than 240 mg/dL. This difference refl ects the higher levels of total cholesterol among older women 

as compared with older men, as noted previously. 

● The Healthy People 2010 objective to reduce the proportion of U.S. adults with high serum

 total cholesterol levels to 17% has been met for the total population of U.S. adults but the

 prevalence of high total cholesterol differs across sex/age groups.

 

The prevalence of high serum total cholesterol levels is below 17% for men aged 20–39 years and 

60 years and older and for women aged 20–39 years. For adults aged 40–59 years, the prevalence 

of high serum cholesterol was approximately 19% for both men and women. 

What proportion of the U.S. population has high serum total cholesterol levels but has 

never been told by a health care provider that they have the condition?

● Approximately 8 percent of U.S. adults had high serum total cholesterol but had never been

 told previously that their cholesterol was high.

Figure 4. Percentage of adults aged 20 years and older who had high serum total 

cholesterol but had never been told by a health care provider that their cholesterol was 

high by age and sex, United States, 2005–2006

Age in years

Percent 1Significant difference from men.

NOTE: High serum total cholesterol defined by serum total cholesterol 240 mg/dL.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Surveys, 2005–2006.

0

5

10

15

20

25

Total 20–39 40–59 60 and older

(1)

Men Women
No. 2 December 2007

5 

NCHS Data Brief 

The proportion of U.S. adults aged 20 years and older who had serum total cholesterol levels 

greater than or equal to 240 mg/dL and who had never been told by a health care provider that they 

had high cholesterol was 7.6% in 2005–2006. 

● The proportion of U.S. adults who had high serum total cholesterol but had never been told 

their cholesterol was high did not differ remarkably by sex or age. 

The proportion of U.S. adults who had serum cholesterol levels greater than or equal to 240 mg/dL 

and who had never been told by a health care provider that they had high blood cholesterol was 

similar for men and women (7.1% and 8.0%, respectively). There was no significant variation by 

age for women, ranging from 7.4% in the youngest age group to 8.8% in those 60 years and older. 

Among men, there were also no large differences in prevalence by age. Prevalence was 7.5%, 

8.0%, and 5.1% in those aged 20–39, 40–59, and 60 years and older, respectively. 

Summary 

High cholesterol is a significant public health problem. Reduction of mean serum total cholesterol 

levels among adults has met the Healthy People 2010 objective of 199 mg/dL, but mean total cholesterol levels differ by age groups and sex. Similarly, the Healthy People 2010 objective to reduce the 

proportion of adults who have high serum total cholesterol levels to 17% has been met but the proportion with high total cholesterol levels differs across age and sex groups. Almost 70% of the adult 

population has obtained recommended screening for high cholesterol, yet 8% of the adult population 

had high serum total cholesterol, but had never been told by a health care provider that they had high 

cholesterol. 

Despite recent advances in medical treatment and public health campaigns to lower dietary intake of 

saturated fat and cholesterol and increase physical activity, high total cholesterol remains a significant public health problem in the United States. 

Other fractions of total cholesterol, specifically LDL and HDL, are needed to assess the clinical risk 

of high total serum cholesterol in individuals (5). These components of cholesterol were not addressed in this analysis. 

Definitions 

Healthy People 2010 Objective (12-13): Reduce the total blood cholesterol levels among adults. 

Target: 199 mg/dL (mean) (3). 

Healthy People 2010 Objective (12-14): Reduce the proportion of adults with high total blood cholesterol levels. Target: 17% (3). 

High serum total cholesterol: total serum cholesterol greater than or equal to 240 mg/dL. 

Never been told by health care provider that cholesterol was high: Based on a negative response to 

the question “Have you ever been told by a doctor or other health care professional that your blood 

cholesterol is high?” 
6 

No. 2 December 2007

NCHS Data Brief 

Screened for high cholesterol in the past 5 years: Defined by an affirmative response to the question 

“Have you ever had your blood cholesterol checked?” and response indicating less than 5 years ago to 

the question “About how long has it been since you last had your blood cholesterol level checked?”. 

Data source 

The National Health and Nutrition Examination Survey (NHANES) data were used for these analyses. NHANES is a cross-sectional survey designed to monitor the health and nutritional status of 

the civilian, noninstitutionalized U.S. population (6). The survey consists of interviews conducted in 

participants’ homes, standardized physical examinations conducted in mobile examination centers, 

and laboratory tests utilizing blood and urine specimens provided by participants during the physical 

examination. 

The NHANES sample is selected through a complex, multistage design that includes selection of primary sampling units (counties), household segments within the counties, and finally sample persons 

from selected households. In 1999–2006, non-Hispanic black persons, Mexican American persons, 

persons with low-income, persons 12–19 years of age, and persons 60 years and older were oversampled in order to obtain reliable estimates of health and nutritional measures for these population 

subgroups. In 1999, NHANES became a continuous survey fielded on an ongoing basis. Each year 

of data collection is based on a representative sample covering all ages of the civilian, noninstitutionalized population. Public-use data files are released in 2-year cycles. 

Sample weights, which account for the differential probabilities of selection, nonresponse and noncoverage, are incorporated into the estimation process. All variance estimates accounted for the 

complex survey design using Taylor series linearization (7). Estimates for the total population and for 

the total population by sex were age-adjusted to the 2000 U.S. standard population using three age 

groups, 20–39, 40–59, and 60 years and over (8). Differences between groups were evaluated using 

a univariate t-statistic. Trend tests were done to evaluate changes in estimates over time. All significance tests were two-sided using p < 0.05 as the level of statistical significance. For comparison of 

estimates by age, adjustments for multiple comparisons were made using the Bonferroni method by 

dividing 0.05 by the number of comparisons (9). All differences reported are statistically significant 

unless otherwise indicated. 

Statistical analyses were conducted using the SAS System for Windows (release 9.1; SAS Institute Inc, Cary NC) and SUDAAN (release 9.0; Research Triangle Institute, Research Triangle Park, 

NC). 

Acknowledgments 

Data files for this report were prepared by the Division of Health and Nutrition Examination 

Surveys, Informatics Branch. This report was edited by Gail V. Johnson, CDC/CCHIS/NCHM/ 

Division of Creative Services, Writer-Editor Services Branch; and layout and graphic production by 

Michael W. Jones, CDC/CCHIS/NCHM/Division of Creative Services, NOVA contractor. 
No. 2 December 2007

7 

NCHS Data Brief 

Suggested citation 

Schober SE, Carroll MD, Lacher DA, Hirsch R. High serum total cholesterol— 

an indicator for monitoring cholesterol lowering efforts; U.S. adults, 2005–2006. NCHS data brief 

no 2, Hyattsville, MD: National Center for Health Statistics. 2007.

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