NCHS Data Brief ■ No. 117 ■ March 2013

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Trends in High LDL Cholesterol, Cholesterol-lowering 

Medication Use, and Dietary Saturated-fat Intake: 

United States, 1976–2010

Elena V. Kuklina, M.D., Ph.D.; Margaret D. Carroll, M.S.P.H.; Kate M. Shaw, M.S.; 

and Rosemarie Hirsch, M.D., M.P.H.

Key findings

Data from the National 

Health and Nutrition 

Examination Survey, 

1976–1980, 1988–1994, 

2001–2004, and 2007–2010

For adults aged 40–74:

•	 The prevalence of high 

low-density lipoprotein 

cholesterol, or LDL–C, 

decreased from 59% to 27% 

from the late 1970s through 

2007–2010.

•	 The percentage of adults 

using cholesterol-lowering 

medication increased from 5% 

to 23% from the late 1980s 

through 2007–2010.

•	 The percentage of adults 

consuming a diet low in 

saturated fat increased from 

25% to 41% from the late 

1970s through 1988–1994.

•	 No significant changes in the

percentage of adults consuming 

a diet low in saturated fat were 

observed from 1988–1994 

through 2007–2010.

Each year, more than 2 million Americans suffer from acute cardiovascular 

events that account for approximately one-fourth of the total cost of inpatient 

hospital care (1). Control of low-density lipoprotein cholesterol (LDL–C) 

has been shown to substantially reduce cardiovascular disease morbidity and 

mortality (2). High LDL–C is LDL cholesterol above the treatment goals 

established by the National Cholesterol Education Program’s Adult Treatment 

Panel III guidelines. It can be managed with lifestyle changes, medications, or 

a combination of these approaches (3). A diet low in saturated fat is recognized 

as one of the most effective lifestyle changes to decrease high LDL–C (4). 

This report evaluates the trends in high LDL–C, use of cholesterol-lowering 

medication, and low dietary saturated-fat intake from 1976–1980 through 

2007–2010 among adults aged 40–74.

Keywords: diet • adults • National Health and Nutrition Examination Survey

The prevalence of high LDL–C decreased from 1976–1980 to 

2007–2010.

Figure 1. Age-adjusted prevalence of high LDL cholesterol among adults aged 40–74, by sex 

and age: United States, 1976–1980 to 2007–2010

1

Significant decreasing linear trend (p < 0.05).

NOTES: High LDL cholesterol is measured levels above the treatment goals established by the National Cholesterol Education 

Program's Adult Treatment Panel III guidelines. Estimates are age adjusted by the direct method to the 2000 U.S. census 

population using age groups 40–64 and 65–74. 

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

0

10

20

30

40

50

60

70

80

Ages 65–74 Men1 Women1 Ages 40–641 1 Total1

59

42

33

27

65

50

38

31

54

37

28

24

56

40

31

27

72

55

43

Percent

30

1976–1980 1988–1994 2001–2004 2007–2010
NCHS Data Brief ■ No. 117 ■ March 2013

■  2  ■

•	 Overall, the prevalence of high LDL–C significantly decreased from 59% in 1976–1980 to

42% in 1988–1994, and to 33% in 2001–2004, reaching 27% in 2007–2010.

•	 Between 1976–1980 and 2007–2010, the prevalence of high LDL–C significantly decreased

for men (65% to 31%), women (54% to 24%), and adults aged 40–64 (56% to 27%) and 

65–74 (72% to 30%) (Figure 1).

The use of cholesterol-lowering medications increased from 1976–1980 

through 2007–2010.

•	 No data on cholesterol-lowering medications were collected in the 1976–1980 study cycle. 

However, other data sources indicate that less than 1% of the population used lipid-lowering 

medication during the 1976–1980 time frame (5).

•	 The use of cholesterol-lowering medication grew from 5% in 1988–1994 to 17% in 

2001–2004, and reached 23% in 2007–2010 (Figure 2).

•	 From 1988–1994 through 2007–2010, the use of cholesterol-lowering medication 

significantly increased for men (5% to 25%), women (6% to 21%), and adults aged 40–64

(4% to 19%) and 65–74 (10% to 39%).

Figure 2. Use of cholesterol-lowering medications among adults aged 40–74 (age adjusted): United States, 1988–1994 

to 2007–2010

1

Significant decreasing linear trend (p < 0.05).

NOTE: Estimates are age adjusted by the direct method to the 2000 U.S. census population using age groups 40–64 and 65–74. 

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

0

10

20

30

40

50

Ages 65–74 Men1 Women1 Ages 40–641 1 Total1

Percent

1988–1994 2001–2004 2007–2010

5

17

23

5

19

25

6

15

21

4

13

19

10

33

39
NCHS Data Brief ■ No. 117 ■ March 2013

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An increased percentage of adults met guidelines for low saturatedfat intake from 1976–1980 to 1988–1994, but the percentage remained 

unchanged from 1988–1994 through 2007–2010.

•	 The percentage of adults meeting guidelines for low saturated-fat intake increased 

significantly from 1976–1980 to 1988–1994, from 25% to 41%, but no significant change

occurred from 1988–1994 through 2007–2010 (Figure 3).

•	 Between 1988–1994 and 2007–2010, the percentage of adults consuming a diet low in 

saturated fat did not change significantly for men, women, and age groups 40–64 and 65–74.

Figure 3. Percentage of adults aged 40–74 meeting guidelines for low saturated-fat intake (age adjusted): United States, 

1976–1980 to 2007–2010

1

p < 0.05 for changes between 1976–1980 and 1988–1994.

NOTES: See “Definitions” section for low saturated-fat intake parameters and “Data source and methods” section regarding dietary recall methodology and food 

database changes between surveys. Estimates are age adjusted by the direct method to the 2000 U.S. census population using age groups 40–64 and 65–74. 

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

0

10

20

30

40

50

60

Ages 65–74 Men1 Women1 Ages 40–641 1 Total1

Percent

1976–1980 1988–1994 2001–2004 2007–2010

25

41 42 42

21

40 41

39

29

42

44 44

24

40 41 42

31

46

48

43
NCHS Data Brief ■ No. 117 ■ March 2013

■  4  ■

Trends are apparent in the prevalence of high LDL–C levels, medication 

use, and dietary intake of low saturated fat.

When high LDL–C, cholesterol-lowering medication use, and low saturated-fat intake during the 

time frame of 1976–1980 through 2007–2010 are presented together, the following patterns can 

be seen (Figure 4):

•	 Among U.S. adults aged 40–74, a substantial decline in the prevalence of high LDL–C, 

from 59% to 27%, was observed between 1976–1980 and 2007–2010.

•	 Significant increases are found in the percentage of adults with low dietary saturated-fat

intake, from 25% to 41%, between 1976–1980 and 2007–2010. However, no significant

changes were observed from 1988–1994 to 2007–2010. These changes were consistent 

among all population subgroups defined by sex and age (Figure 3).

•	 In contrast, use of cholesterol-lowering medication continued to grow steadily, from 5% to 

23%, between 1988–1994 and 2007–2010.

Figure 4. Age-adjusted trends in prevalence of high LDL cholesterol, use of cholesterol-lowering medications, and low 

saturated-fat intake among adults aged 40–74: United States, 1976–1980 to 2007–2010

1

Significant decreasing linear trends from 1976–1980 to 2007–2010 (p < 0.05). 2

Significant increase from 1976–1980 to 1988–1994 (p < 0.05); no significant change from 1988–1994 to 2007–2010. 3

Significant increasing trend from 1988–1994 to 2007–2010.

NOTES: Data on the use of cholesterol-lowering medication was not collected in 1976–1980. High low-density lipoprotein (LDL) cholesterol is measured levels 

above the treatment goals established by the National Cholesterol Education Program's Adult Treatment Panel III guidelines. Estimates are age adjusted by the 

direct method to the 2000 U.S. census population using age groups 40–64 and 65–74. 

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

0

10

20

30

40

50

60

70

1976–1980 1988–1994 2001–2004 2007–2010

High LDL cholesterol1

Cholesterol-lowering 

medication use3

Met less than 10% of kilocalories 

from saturated fat per day2

59

25

0

42

41

5

42

33

17

42

27

23
NCHS Data Brief ■ No. 117 ■ March 2013

■  5  ■

Summary

From 1976–1980 through 2007–2010, for U.S. adults aged 40–74, a decrease was observed in 

the prevalence of high LDL–C, as well as an increase in adults using lipid-lowering medications 

and consuming a diet low in saturated fat. A substantial decline in the prevalence of high LDL–C 

from 59% to 28% was seen over this same time period. There also were significant increases in

the percentage of adults meeting federal dietary guidelines (6) for low dietary saturated-fat intake, 

from 25% to 42%, between 1976–1980 and 2007–2010; however, no significant changes were

observed from 1988–1994 to 2007–2010. Although declines in the proportion of calories from 

saturated fat have occurred since the 1970s, the average dietary energy intake has increased (7). 

Use of cholesterol-lowering medication continued to grow steadily, from 5% to 23%, from 

1988–1994 to 2007–2010.

Despite recent advances in medical treatment, high cholesterol remains a significant public health

problem in the United States, with more than one-quarter of adults aged 40–74 having high 

LDL–C. These findings may provide useful information for evaluation of programs and policy

initiatives aimed at reducing the prevalence of high cholesterol in the adult population.

Definitions

Note: For all definitions listed, the denominator is total population.

High LDL cholesterol (LDL–C): Measured levels of LDL–C above the treatment goals 

established by the National Cholesterol Education Program’s Adult Treatment Panel (ATP) III 

guidelines: less than 160 milligrams per deciliter (mg/dL) for low-risk groups, less than 130 

mg/dL for intermediate-risk groups, and less than 100 mg/dL for high-risk groups (3). Persons 

defined as having high LDL–C may or may not have been taking medication.

Use of cholesterol-lowering medication: Interviewed participants were identified as current users

of cholesterol-lowering medication if they answered “yes” to the question: “To lower your blood 

cholesterol, are you now following this advice to take prescribed medicine?” Note that data on 

the use of cholesterol-lowering medication are not available for the second National Health and 

Nutrition Examination Survey (NHANES II), 1976–1980.

Low saturated-fat intake: Meeting ATP guidelines for consumption of less than 10% of total 

kilocalories from saturated fat (6), specifically the 24-hour period prior to the dietary recall

interview (midnight to midnight), where total kilocalorie intake includes kilocalories from 

protein, carbohydrate, total fat, and alcohol. Standard conversion factors were used to convert 

grams of saturated fat to kilocalories: 9 kilocalories per gram. The percentage of kilocalories from 

saturated fat was then calculated by dividing the caloric intake from saturated fat by the total 

daily caloric intake, and multiplying this fraction by 100.
NCHS Data Brief ■ No. 117 ■ March 2013

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Data source and methods

Data from NHANES conducted during four study cycles—1976–1980, 1988–1994, 2001–2004, 

and 2007–2010—for adults aged 40–74 were used in this report. NHANES is a cross-sectional 

survey designed to monitor the health and nutritional status of the civilian noninstitutionalized 

U.S. population. The survey consists of interviews conducted in participants’ homes and 

standardized physical examinations in mobile examination centers (MECs), including laboratory 

tests. One-half of participants aged 12 and over who participated in the MEC exam were randomly 

assigned to the morning sample and instructed to fast for at least 8 hours up to 24 hours prior to 

venipuncture. The prevalences of high LDL–C are based on persons examined in the morning and 

fasting for 8.5 up to 24 hours prior to venipuncture. The dietary saturated-fat data for this report 

were collected from in-person, 24-hour dietary recall interviews in the MEC. Dietary recalls 

cover intake during the day (24 hours) prior to the standardized physical examination at the MEC. 

Improvement in dietary intake methodology and food composition databases, as well as changes 

in food composition, occurred during the time frame of 1976–1980 through 2007–2010 (7).

All variances were estimated by Taylor series linearization. Prevalence estimates were age 

adjusted by the direct method to the 2000 U.S. census population using the age groups 40–59 and 

60–74. The following sample weights were incorporated in prevalence estimates and standard 

errors: fasting subsample weights for high LDL–C; interview weights for cholesterol medication 

use; MEC weights for saturated-fat intake estimates for 1976–1980 and 1988–1994; and dietary 

day-one weights for 2001–2004 and 2007–2010. Differences between groups were tested using 

a t statistic with the appropriate number of degrees of freedom at the p < 0.05 significance level.

Adjustments were not made for multiple comparisons. Statistical hypotheses of no linear trends 

were tested using orthogonal contrasts matrices. Statistical analyses were conducted using SAS 

release 9.3 (SAS Institute, Cary, N.C.) and SUDAAN release 10.0 (RTI International, Research 

Triangle Park, N.C.).

About the authors

Elena V. Kuklina and Kate M. Shaw are with the Centers for Disease Control and Prevention’s 

(CDC) National Center for Chronic Disease and Health Promotion, Division for Heart Disease 

and Stroke Prevention.

Margaret D. Carroll and Rosemarie Hirsch are with CDC’s National Center for Health Statistics, 

Division of Health and Nutrition Examination Surveys.
NCHS Data Brief ■ No. 117 ■ March 2013

■  7  ■

References

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Holland LE, Reith C, et al. Efficacy and safety of more intensive lowering of LDL cholesterol:

A meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet 376(9753):

1670–81. 2010.

3. National Institutes of Health, National Heart, Lung, and Blood Institute, National Cholesterol 

Education Program. Third report of the Expert Panel on Detection, Evaluation, and Treatment of 

High Blood Cholesterol in Adults (Adult Treatment Panel III). Bethesda, MD: National Institutes 

of Health. 2002. Available from: http://www.nhlbi.nih.gov/guidelines/cholesterol/index.htm.

4. Kelly RB. Diet and exercise in the management of hyperlipidemia. Am Fam Physician 

81(9):1097–102. 2010.

5. National Center for Health Statistics, National Heart, Lung, and Blood Institute Collaborative 

Lipid Group. Trends in serum cholesterol levels among US adults aged 20 to 74 years. JAMA 

257(7):937–42. 1987.

6. U.S. Department of Agriculture, U.S. Department of Health and Human Services. Dietary 

guidelines for Americans, 2010. 7th ed. Washington, DC: U.S. Government Printing Office. 2010.

7. Briefel RR, Johnson CL. Secular trends in dietary intake in the United States. Annu Rev Nutr 

24:401–31. 2004.
NCHS Data Brief ■ No. 117 ■ March 2013

Suggested citation

Kuklina EV, Carroll MD, Shaw KM, 

Hirsch R. Trends in high LDL cholesterol, 

cholesterol-lowering medication use, and 

dietary saturated-fat intake: United States, 

1976–2010. NCHS data brief, no 117. 

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

Edward J. Sondik, Ph.D., Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Health and Nutrition 

Examination Surveys

Lisa Broitman, M.P.A., Acting Director

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