NCHS Data Brief ■ No. 132 ■ October 2013

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

High levels of total cholesterol and low levels of high-density lipoprotein 

(HDL) cholesterol (the “good cholesterol”) are risk factors for coronary heart 

disease (1–5). To identify persons who may be at risk for developing coronary 

heart disease, adults are advised to have their cholesterol checked at least 

once every 5 years (i.e., to be screened for cholesterol) (6). A previous study 

reported declining trends in the percentage of adults with high total cholesterol 

during 1999–2010 (7). This report presents estimates of the percentages of 

adults aged 20 and over with high total cholesterol, low HDL cholesterol, and 

screened for cholesterol, based on data from 2011–2012, and compares them 

with corresponding estimates from 2009–2010. Analysis is based on measured 

cholesterol only and does not take into account whether lipid-lowering 

medications were taken.

Keywords: cholesterol screening • total cholesterol • HDL cholesterol

During 2011–2012, 12.9% of adults had high total cholesterol, 

17.4% had low HDL cholesterol, and 69.4% had been 

screened for cholesterol.

Key findings

Data from the National 

Health and Nutrition 

Examination Survey, 

2011–2012

•	 In 2011–2012, an estimated 

12.9% of U.S. adults aged 20 

and over (11.1% of men and 

14.4% of women) had high 

total cholesterol, which is 

unchanged since 2009–2010.

•	 Approximately 17% of 

adults (just over one-quarter 

of men and less than 10% of 

women) had low high-density 

lipoprotein (HDL) cholesterol 

during 2011–2012. The 

percentage of adults with low 

HDL cholesterol has decreased 

20% since 2009–2010.

•	 Nearly 70% of adults (67% 

of men and nearly 72% of 

women) had been screened for 

cholesterol, which is unchanged 

since 2009–2010.

Total and High-density Lipoprotein Cholesterol in Adults: 

National Health and Nutrition Examination Survey, 2011–2012

Margaret D. Carroll, M.S.P.H.; Brian K. Kit, M.D., M.P.H.; David A. Lacher, M.D., M.Ed.; and 

Sung Sug (Sarah) Yoon, R.N., Ph.D.

Figure 1. Age-adjusted percentage of adults aged 20 and over with high total cholesterol, low HDL 

cholesterol, and screened for cholesterol: United States, 2009–2010 and 2011–2012

1

Significant decrease between 2009–2010 and 2011–2012 (p < 0.05). 

NOTES: HDL is high-density lipoprotein. High total cholesterol is 240 mg/dL; low HDL cholesterol is <40 mg/dL; screened for 

cholesterol is having cholesterol checked within the past 5 years. 

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2009–2010 and 2011–2012.

2009–2010 2011–2012

Percent

0

20

40

60

80

100

High total cholesterol Low HDL cholesterol Screened for cholesterol

13.4 12.9

21.3

67.9 69.4

1

17.4
NCHS Data Brief ■ No. 132 ■ October 2013

■  2  ■

The percentage of adults with low HDL cholesterol has decreased since 2009–2010, but neither 

the percentage with high total cholesterol nor the percentage screened for cholesterol changed 

during this time period (Figure 1).

During 2011–2012, the percentage of adults with high total cholesterol, low 

HDL cholesterol, and screened for cholesterol differed by sex.

A higher percentage of women (14.4%) than men (11.1%) had high total cholesterol, and a higher 

percentage of women (71.8%) than men (66.9%) had been screened for cholesterol (Figure 2). 

However, a lower percentage of women (9.0%) than men (26.4%) had low HDL cholesterol. 

Figure 2. Age-adjusted percentage of adults aged 20 and over with high total cholesterol, low HDL cholesterol, and 

screened for cholesterol, by sex: United States, 2011–2012

1

Significantly different from men. 

NOTES: HDL is high-density lipoprotein. High total cholesterol is 240 mg/dL; low HDL cholesterol is <40 mg/dL; screened for cholesterol is having cholesterol 

checked within the past 5 years. 

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2011–2012.

Men Women

High total cholesterol Low HDL cholesterol Screened for cholesterol

Percent

0

20

40

60

80

100

11.1 1

14.4

26.4

66.9

1

71.8

1

9.0
NCHS Data Brief ■ No. 132 ■ October 2013

■  3  ■

The percentage of adults with high total cholesterol during 2011–2012 

differed by race and Hispanic origin.

Non-Hispanic black adults had consistently lower percentages with high total cholesterol (9.8% 

overall, 7.4% for men, and 11.5% for women) than non-Hispanic white adults (13.5% overall, 

11.6% for men, and 15.2% for women) (Figure 3). The percentage with high total cholesterol was 

also lower for non-Hispanic black adults overall (9.8%) than for Hispanic adults overall (14.2%) 

and for men (7.4% non-Hispanic black and 14.2% Hispanic), but not for women. For 

non-Hispanic Asian adults overall, and for non-Hispanic Asian men and women, the percentage 

with high total cholesterol did not differ significantly from the percentages for the three other 

racial and ethnic groups. 

Figure 3. Age-adjusted percentage of adults aged 20 and over with high total cholesterol, by sex and race and Hispanic 

origin: United States, 2011–2012

1

Significantly different from non-Hispanic black (p < 0.05). 

2

Significantly different from non-Hispanic black (p < 0.01).

NOTE: High total cholesterol is serum total cholesterol 240 mg/dL. 

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2011–2012. Percent

Non-Hispanic white Non-Hispanic black Non-Hispanic Asian Hispanic

Both sexes Men Women

1

13.5

9.8 10.3

2

14.2 2

11.6

2

14.2

9.5

7.4

2

15.2

11.5 10.9

14.1

0

10

20

30

40

50
NCHS Data Brief ■ No. 132 ■ October 2013

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The percentage of adults with low HDL cholesterol during 2011–2012 also 

differed by race and Hispanic origin.

The percentage of adults with low HDL cholesterol was lower in non-Hispanic black adults than 

in non-Hispanic white adults, and higher in Hispanic adults than in non-Hispanic black or 

non-Hispanic white adults (Figure 4). These racial and ethnic differences were also observed in 

men but not in women. Non-Hispanic Asian adults had consistently lower percentages with low 

HDL cholesterol (14.3% overall, 24.5% for men, and 5.1% for women) than Hispanic adults 

(21.8% overall, 32.6% for men, and 11.3% for women).

Figure 4. Age-adjusted percentage of adults aged 20 and over with low HDL cholesterol, by sex and race and Hispanic 

origin: United States, 2011–2012

1

Significantly different from Hispanic (p < 0.05). 

2

Significantly different from non-Hispanic black (p < 0.05). 

3

Significantly different from Hispanic (p < 0.01). 

NOTES: HDL is high-density lipoprotein. Low HDL is <40 mg/dL.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2011–2012. Percent

Non-Hispanic white Non-Hispanic black Non-Hispanic Asian Hispanic

Both sexes Men Women

1,217.1

3

12.7 3

14.3

21.8

1,225.4

32.6

1

24.5

3

19.1

9.3 7.8 3

5.1

11.3

0

10

20

30

40

50
NCHS Data Brief ■ No. 132 ■ October 2013

■  5  ■

During 2011–2012, the percentage of adults screened for cholesterol also 

differed by race and Hispanic origin.

Overall, and for both men and women, the percentage of adults screened for cholesterol was 

lower for Hispanic adults than for non-Hispanic white, non-Hispanic black, and non-Hispanic 

Asian adults (Figure 5).

Figure 5. Age-adjusted percentage of adults aged 20 and over screened for cholesterol, by sex and race and Hispanic 

origin: United States, 2011–2012

1

Significantly different from Hispanic (p < 0.001). 

2

Significantly different from women of the same racial and ethnic group (p < 0.01).

NOTE: Screened for cholesterol is having cholesterol checked within the past 5 years.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2011–2012. Percent

Non-Hispanic white Non-Hispanic black Non-Hispanic Asian Hispanic

Both sexes Men Women

1

71.8 1

71.9 1

70.8

59.3

1,70.6

2

54.6

1

70.6 1,266.8

1

72.9 1

75.9 1

70.9

64.2

0

20

40

60

80

100

Summary

Although the percentage of adults aged 20 and over with high total cholesterol declined 

substantially from 1999 to 2010 (7), there was no change between 2009–2010 and 2011–2012. 

There was also no change in the percentage of adults screened for cholesterol. However, the 

percentage of adults with low HDL cholesterol decreased. 

The differences by sex and race and Hispanic origin observed for high total cholesterol, low HDL 

cholesterol, and screened for cholesterol during 2009–2010 were also observed during 2011–2012 

(7). New with the 2011–2012 data is the ability to provide estimates for the non-Hispanic Asian 

population. The percentage of non-Hispanic Asian adults with high total cholesterol did not differ 

significantly from that of the other three racial and ethnic groups. However, non-Hispanic Asian

adults had consistently lower percentages with low HDL cholesterol and consistently higher 

percentages screened for cholesterol, compared with Hispanic adults.

The Healthy People 2020 (8) target for high total cholesterol of no more than 13.5% (objective 7) 

was achieved in all adults and in all sex and racial and ethnic groups except for women overall, 

Hispanic men, and non-Hispanic white women. However, none of the sex and race and Hispanic 

origin groups attained the Healthy People 2020 target for cholesterol screening of at least 82.5% 

(objective 6). 
NCHS Data Brief ■ No. 132 ■ October 2013

■  6  ■

Definitions

High total cholesterol: Serum total cholesterol greater than or equal to 240 mg/dL (6).

Low HDL cholesterol: Serum HDL cholesterol less than 40 mg/dL (6).

Screened for high cholesterol: Defined by an affirmative response to the question, “Have you

ever been told by a doctor your cholesterol was high?” and a 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?”

Healthy People 2020: Heart Disease and Stroke, Objective 6: Increase the proportion of adults 

who have had their blood cholesterol checked within the preceding 5 years; target: 82.5% (8).

Healthy People 2020: Heart Disease and Stroke, Objective 7: Reduce the proportion of adults 

with high total blood cholesterol levels; target: 13.5% (8).

Data source and methods

Data from the National Health and Nutrition Examination Surveys (NHANES) 2009–2010 

and 2011–2012 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 (9). 

It is conducted by the Centers for Disease Control and Prevention’s (CDC) National Center for 

Health Statistics (NCHS). The survey consists of interviews conducted in participants’ homes, 

standardized physical examinations conducted in mobile examination centers (MECs), and 

laboratory tests using blood specimens provided by participants during the physical examination. 

Details on the laboratory methods are available elsewhere (9).

The NHANES sample is selected through a complex, multistage probability design. In 

2011–2012, non-Hispanic Asian, non-Hispanic black, and Hispanic persons; persons with 

low income (below 130% of the federal poverty level); and those aged 60 and over were 

oversampled to obtain reliable estimates of health and nutritional measures for these population 

subgroups. 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 (9).

Sample weights (which account for the differential probabilities of selection, nonresponse, 

and noncoverage) are incorporated into the estimation process. The MEC examination weight 

was used in estimating the prevalence of high total cholesterol and low HDL cholesterol. The 

interview weight was used to estimate the prevalence of cholesterol screening. All variance 

estimates accounted for the complex survey design by using Taylor series linearization (10).

Prevalence estimates for the total adult population were age-adjusted by the direct method to the 

2000 U.S. census population, using age groups 20–39, 40–59, and 60 and over (11). Differences 

between groups were tested using Student’s t statistic with the appropriate number of degrees of 

freedom, at the p < 0.05 significance level. All differences reported are statistically significant

unless otherwise indicated. Adjustments were not made for multiple comparisons. Statistical 

analyses were conducted using the SAS System for Windows, release 9.3 (SAS Institute, Inc., 

Cary, N.C.) and SUDAAN, release 11.0 (RTI International, Research Triangle Park, N.C.).
NCHS Data Brief ■ No. 132 ■ October 2013

■  7  ■

About the authors

Margaret D. Carroll, Brian K.Kit, David A. Lacher, and Sarah Yoon are with CDC’s National 

Center for Health Statistics, Division of Health and Nutrition Examination Surveys. 

References

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of coronary heart disease in the Framingham Offspring Study: Role of lipoprotein cholesterol. 

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as a predictor of coronary heart disease risk: The PROCAM experience and pathophysiological 

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Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment 

Panel III). Final report. NIH Pub. No. 02–5215. Bethesda, MD: National Institutes of Health, 

National Heart, Lung, and Blood Institute. 2002. Available from: http://www.nhlbi.nih.gov/

guidelines/cholesterol/atp3full.pdf.

7. Carroll MD, Kit BK, Lacher DA. Total and high-density lipoprotein cholesterol in adults: 

National Health and Nutrition Examination Survey, 2009–2010. NCHS data brief, no 92. 

Hyattsville, MD: National Center for Health Statistics. 2012. Available from: http://www.cdc.gov/

nchs/data/databriefs/db92.pdf.

8. U.S. Department of Health and Human Services, Office of Disease Prevention and Health 

Promotion. Healthy People 2020 topics and objectives: Heart disease and stroke. Washington, 

DC. Available from: http://healthypeople.gov/2020/topicsobjectives2020/objectiveslist.

aspx?topicId=21.

9. National Center for Health Statistics. National Health and Nutrition Examination Survey: 

NHANES 2011–2012. Available from: http://www.cdc.gov/nchs/nhanes/nhanes2011-2012/

nhanes11_12.htm.

10. Wolter KM. Introduction to variance estimation. 2nd ed. New York, NY: Springer 

Science+Business Media. 2007.
NCHS Data Brief ■ No. 132 ■ October 2013

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11. Klein RJ, Schoenborn CA. Age adjustment using the 2000 projected U.S. 

population. Healthy People 2010 Statistical Notes, no 20. Hyattsville, MD: 

National Center for Health Statistics. 2001. Available from: http://www.cdc.

gov/nchs/data/statnt/statnt20.pdf.

Suggested citation

Carroll MD, Kit BK, Lacher DA, Yoon 

SS. Total and high-density lipoprotein 

cholesterol in adults: National Health and 

Nutrition Examination Survey, 2011–2012. 

NCHS data brief, no 132. Hyattsville, MD: 

National Center for Health Statistics. 2013.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Charles J. Rothwell, M.S., Acting Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Health and Nutrition

 Examination Surveys

Kathryn S. Porter, M.D., M.S., Director

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