FROM VITAL & HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEALTH STATISTICS 

US. DEPARTMENT OF HEALTH, EOUCATION, AND WELFARE ] No. 7 May 25, 1977 [ Public Health Service - Health Resources Administration 

Total Serum Cholesterol Level of Adults 18-74 Years of Age, 

United States, 1971-74a 

The se~um cholesterol level in this report 

were obtained as a part of the Health and Nutrition Examination Survey (HANES). HANES is a 

program of the National Center for Health Statistics in which measures of nutritional status are 

collected for a scientifically designed sample representative of the civilian, noninstitutionaIized 

population of the United States in a broad range 

~fages, 1-74 years.1 � Field data collection operations for the first 

HANES survey were started in ApriI 1971 and 

completed in June 1974. Of the 28,043 persons 

aged 1-74 years who were selected in the national probability sample to represent the 194 milIion persons in that age group in the civiIian noninstitutionalized population, 20,749, or 74 percent, were examined. When adjustments were 

made for the differential sampling ratios used 

for the effect of oversampling among the poor, 

.	 preschool children, women of childbearing age, 

and the elderly, this corresponds to an effective 

response rate of 75 percent. There were 13,645 

people ages 18-74 years on whom serum cholesterol level determinations were made. Selected 

“ from the nationzd probability sample of 19,572, 

these individuals represented the 128 million of 

that age group in the population. This is an unadjusted response rate of 70 percent and an effective adjusted response rate of 70 percent. Detailed estimates of the distribution of serum cholesterol levels wiIl be described and analyzed in a 

forthcoming report in Series 11 Z of Vital and 

Health Statistics. Selected data and findings 

� aThisreportpreparedby Sidney Abraham, Clifford L. 

Johnson, and Margaret D. Carrel. 

from that report are presented in tables 1-5 and 

figures 1-3 of this Advance Data. 

Serum cholesterol leveIs have been identified 

as one of the important multiple risk factors in 

the development of coronary heart disease. The 

results of epidemiologic studies based on adult 

data from Longitudinal studies such as the Framingham Heart Study3 have demonstrated that 

persons with elevated serum cholesterol values 

developed coronary heart disease with greater 

frequency. Serum cholesterol levels of adults 

aged 18-74 years are presented and analyzed by 

age, sex, and race because of medical interest in 

such data. HAIJES provided cross-sectional data 

of serum cholesterol leveIs obtained on different 

age cohorts representative of the U.S. population. The age trends represented mean levels for 

successive cohorts of different age groups. The 

limitation of cross-sectional data are recognized 

in considering group age changes because they 

reflect effects of environmentzd as well as developmental and heredity influences. 

All serum cholesterol determinations for 

HANES were made in the Lipid Standardization 

Laboratory of the Center for Disease Control 

(CDC), PubIic Health Service, Atlanta, Georgia. 

The analytical method was based on that of 

Abell et al.,4, but was modified for a semiautomated production line. The method, described 

in detail by Eavenson et al.b was made possible 

by the development of a relatively stable Liebermarm color reagent and was designed for automatic pipetting units. 

The Lipid Laboratory compared the results 

obtained with this semiautomated method with 

those obtained from their standardized version.A 

To examine the bias of the semiautomated 
� 2 acklncedata 

method, data were obtained from pools of sera 

analyzed by the reference method and by the 

semiautomated method. In 1972, pook ranging 

from 134 to 343 mg per 100 ml had an average 

positive bias of 4.07 percent for the semiautomated method as compared to the standard 

method; for the 1973-74 period, the corresponding figure was a positive bias of 4.9 percent. The 

weighted average bias was 4.5 percent. The 

1971-1974 data in this report are presented 

without correction for bias so that they provide 

population reference standards for determinations made by the semiautomated methodoloaq 

now in use. However, in the series report, 

HANES’ 1971-1974 serum cholesterol data are 

corrected for bias when HAN13S data are compared with Health Examination Survey data of 

1960-1962. 

PRINCIPAL FINDINGS 

For men, the lowest mean serum cholesterol 

level occurs in the youngest age group measured, 

18-24 years. However, the mean level increases 

steadily with age until the age group 35-44 

Figure 1. MEAN SERUM CHOLESTEROL LEVELS OF ADULTS 

BY SEX AND AGE: UNITED STATES, 1971-74 

270


r 261.6 

. . . .

260 – 266,8 . . . . . ...”””” . . . . 

/ 

~ 250 — . ..”” 

242:....”’”” 24,2 z 

: 240 

k 231,3 

~ 230 — 

g 

~ 220 

a 

# 

W 210 

. 

0 

z 

u 200 

z 

3 — Men 

~ 190 . . . . . . Women 

z 186,9 

< 

180 !! 

170 

1

} 

)’ 

I I I I I 

?8.24 25.34 35.44 45.54 55.64 65-74 

AGE IN YEARS 

years. Then, it increases by a smalI increment to age group measured, 65-74 years (table 1, figure


a maximum level of 240.2 mg per 100 ml at the 1).


age group 55-64 years, declining slightly to a For women, the mean serum cholesterol


mean level of 236.2 mg per 100 ml at the oldest Ievels do not parallel those of men in the same


Table 1. Serum cholesterol level of adults 18-74 years by sex and age with mean, standard deviation, and standard error of the mean: 

United States, 1971-74 

Age 

All ages 

18-74 years ..... ...... 

18-24 years .................. 

25-34 years .................. 

35-44 years ............ ...... 

45-54 years ..... ............. 

55-64 years .... .............. 

65-74 years .................. 

Meanl 

223.4 

189.4 

206.6 

223.6 

241.1 

248.9 

250.7 

Both saxes 

Standard Standard error of T deviation

the mean 

+ 

39.0 1.41 

43.2 1.42 

45.3 1.50 

49.7 1.48 

50.3 2.48 

54.2 1.35 

Meanl 

221.8 

186.9 

210.3 

231.3 

239.4 

240.2 

236.2 

Men I Women 

49.9 1.09 224.9 52.8 0.99 

.— 

36.7 1.89 191.7 41.0 1.92 

44.0 2.27 203.2 42.2 1.39 

45.9 2.53 216.5 43.5 1.37 

47.0 2.54 242.6 52.0 2.36 

51.2 3.17 256.8 48.2 2.72 

53.8 2.05’ 261.6 51.9 1,92 � 

lMg per 100 ml. 
3


age groups. The serum cholesterol leveIs am 

slightly higher for women than for men in the 

age group 18-24 years. However, in the older age 

groups, there is a slight but consistently higher 

mean serum cholesterol level for men as compared with that for women until the age group 

45-54 years. Thereafter the mean levels for men 

show a plateau effect and a slight decrease, while 

the mean levels for women continue upward to 

256.8 mg per 100 mI at age 55-64 years and to a 

maximum value of 261.6 mg per 100 ml at the 

age group 65-74 years (table 1, figure 1). 

The standard deviations of the distributions 

by age and sex are shown in table 1. The variability within each age and sex group increases 

with age as indicated by the standard deviations. 

Although the differences are small, men show 

greater variations around their mean Ievels at 

most age groups than women do. The percent 

distribution of men and women 18-74 years of 

age falling into each of the 16 groups according 

to their levels of cholesterol are shown in tables 

2 and 3. 

Mean serum cholesterol levels for white men 

are consistently higher than those for Ne~o men 

at ages 18-24, 35-44, and 45-54. The differences 

in mean Ievels range from 2.3 to 6.8 mg per 100 

ml.	 The same direction is not evident at ages 

25-34 and ages 55 years and older, when Negro 

men have higher mean serum cholesterol levels 

than those of white men. However, the differences in mean Ievels are small and range from 

1.0 to 4.3 mg per 100 ml (table 4 and figure 2). 

The mean serum cholesterol level for white 

and Negro men generally increases with age. The 

mean level for white men increases rapidly to 

the age group 3544 years. The mean level then 

continues upward at a slower rate of increase, 

reaching a peak of 239.9 mg per 100 ml at ages 

45-64 years, and declines slightIy thereafter. The 

mean levels for Neqo men also increase with age 

but at a slower rate; they are sIightly higher at 

the older ages and peak at a later age–55-64 

years-than those for white men. A slight decline 

in mean level also occurs in the age group 65-74 

years. 

Table 4 and figure 3 show that mean serum 

cholesterol levels for NTegro women are consistently higher than those of whke women in the 

age groups under age 65 years. In the oldest age 

group measured, 65-74 years, the mean levels for 

white women are slightly higher than those for 

Negro women, a difference of 2.1 mg per 100 

ml. The mean IeveIs for Neqo and white women 

Table 2. Percent distribution of serum cholesterol levels of men by age: United States, 1971-74 

All 

Serum cholesterol level ages 18-24 25-34 35-44 45-54 55-64 65-74 

(mg per 100 ml) 18-74 years yeers years years years years 

years 

Total ............................................. 

Under 100 ...................................... ..... 

100-119 ............................................... 

120-139 ............................................... 

140-159 ............................................... 

160-179 .............................................. 

180-199 .............................................. 

200-219 .............................................. 

220-239 .............................................. 

240-259 .............................................. 

260-279 .............................................. 

280-299 .............................................. 

300-319 .............................................. 

320-339 .............................................. 

340-359 .............................................. 

360-379 .............................................. 

380 or more ........................................ 

Percent distribution 

100.0 100.0 100.0 100.0 100.0 100.0 100.0 

0.1 0.1 0.4 0.1 0.2 

0.4 1.0 0.3 0.1 0.3 0.0 0.3 

2.1 5.6 2.8 0.8 0.3 1.3 1.2 

5.6 16.4 5.3 2.3 3.0 1.1 2.8 

11.5 23.5 15.4 9.1 5.4 4.4 5.9 

15.6 23.1 20.6 12.9 8.3 13.6 12.3 

16.2 13.4 19.9 18.1 16.4 12.8 17.3 

16.0 7.4 13.9 17.2 20.1 23.2 16.0 

12.0 5.5 9.8 14.3 15.7 13.8 14.8 

8.8 2.0 5.6 11.7 11.3 12.7 12.7 

4.6 0.8 3.4 4.8 7.3 6.2 7.1 

3.3 1.0 0.9 3.3 6.5 5.3 4.3 

1.7 0.0 0.8 3.7 1.6 2.2 2.4 

1.1 0.2 0.3 1.1 2.9 1.2 0.8 

0.3 0.4 0.0 0.2 0.9 0.9 

0.6 0.6 0.6 0.3 1.2 1.0 

NOTE: Percents may not add to 100.0 due to rounding. 
4 achtancedata 

o 

figure 2. MEAN SERUM CHOLESTEROL LEVELS OF MEN Figure 3. MEAN SERUM CHOLESTEROL LEVELS OF WOMEN 

BY AGE AND RACE: UNITED STATES, 1971-74 BY AGE AND RACE: UNITED STATES, 1971-74 

270 270 r r 

I 280.s 261.8 

260 260 — 

t 

~ 250 — $ 250 — 

243,8 

z 2.399 g 

; 240 — = 240 — 

!+ 2363 & 

: 230 — ~ 230 — 

g g 

g 

K 220 — & 

a 

220 — 216,9 

.. 

: ... r 

% 210 — 210 — A q 

0 0 x z 

o 200 ... z z 3 — White = 194,7 ,.” — White 

g 190 . . . . . . Negro	 u . . . ..- Negr; 

: 

z < < 

z 180 — SJ 180 

} 

J’ J’ 

o I I I I I o I I I I I 

18-24 25-34 35.44 45.54 55.64 66.74 18.24 25-34 35.44 45.64 55.64 65-74 

AGE IN YEARS AGE IN YEARS 

Table 3. Percent distribution of serum cholesterol levels of women by age: United States, 1971-74 

All 

Serum cholesterol level ages 18-24 25-34 3544 45-54 55-64 65-74 

(mg per 100 ml) 18-74 years years years yea rs years years 

years 

Percent distribution 

Total ... ........... ........................... 100.01 100.0 100.0 100.0 100.0 100.0 . 100.0 

Under 100 .............. .. ........................... 0,1 0.3 0.3 0.1 

loo.l19 ......... .... ..................... ............ 0.4 1.2 0.6 0.3 0.1 0.1 0.4 

120.139 ............... ...... ................ ...... ..... 2.2 6.1 3.1 1.3 0.6 0.2 0.8 

140.159 .................... ................ ............ 5.8 13.6 8.1 4.9 2.6 1.0 1.6 

160.179 .............. .................................. 10.6 21.1 16.2 11.0 5.0 2.6 2.0 

180.199 ............ .......................... .......... 15.2 19.6 21.8 19.0 11.7 7.4 5.1 

200.219 ................................................ 16.2 14.9 20.6 21.5 15.4 11.8 9.1 

220.239 ................................................ 14.6 11.9 12.2 16.4 18.5 14.8 14.3 

240.259 ... ................ ............................. 11.7 5.7 8.0 11.8 14.4 16.2 17.7 

260.279 ................................................ 9.1 3.2 5.4 6.3 12.0 16.8 14.7 

280.299 ..... ........................................... 5.6 0.9 1.6 3.2 8.1 10.8 13.6 

3oo.319 ................................................ 3.8 0.9 1.0 2.5 3.9 8.9 9.0 

320.339 ................................... ............. 2.2 0.4 0.4 1.0 3.3 4.4 5.4 

340.359 .................... ............................ 1.0 0.0 0.3 0.3 1.2 2.0 3.0 

36&379 ................................................ 0.8 0.1 0.1 1.7 1.9 1.8 

380 or more .. .. .. .. .. .. .. .. .. .. .. .... .. .. .... .. .. .... 0.7 0.2 0.3 0.3 1.5 1.1 1. 

* 

NOTE: Percents may not add to 100.0 due to rounding. 
m 

increase with age to 55-64 years. Then the mean 

level for Negro women declines slightly while it 

continues to rise less rapidly for white women 

aIthough it slightly exceeds the Negro women’s 

level. 

Age not only affects the comparison of 

mean serum cholesterol levels between races but 

also the comparison levels between sexes. For 

example, the mean levels of white and Negro 

men in the youngest age group measured, 18-24 

years, are slightly lower than the mean leveIs for 

women of both races at the same age (table 4). 

AIthough a crossover occurs in the midthirties, 

the pattern reverses again after age 45, when the 

mean levels for women are higher and increase 

more rapidly than those for men, particularly 

after age 55. 

The distribution of serum cholesterol levels 

was also used to note the proportion of persons 

in any race-sex-age group that exceeds the level 

of 260 mg per 100 ml and more. These measurements were used to estimate the prevalence of 

elevated serum cholesterol levels. Although there 

is no statistical information regarding the actwd 

level of serum cholesterol separating “high” 

from ‘low” risk individuals, the level of 260 mg 

per 100 ml has been cited in studies to distinguish “high” from “less high” or ‘low”. 

� 

a&me&ta5 

Among men, proportions varied from a low 

of 4.0 percent in age group 18-24 years to a high 

of 30.1 percent in age group 45-54 years. The 

level then declines to about 29 percent at ages 

55 and older (table 5). 

Among women, the Iowest proportion also 

occurs at the youngest age group measured— 

18-24 years-with the proportion increasing 

steadily with age until it reaches a maximum of 

49.2 percent at the age group 65-74 years. 

At the youngest age group measured, 18-24 

years, and at the ages of 45 years and older, 

there are higher proportions of women with serum cholesterol levels of 260 mg per 100 ml and 

more than there are of men. This pattern is not 

evident for age groups 25-34 and 35-44 years 

when the proportions are higher for males than 

for females. In the age groups 18-24 and 45-54 

years, the differences in proportions between 

the sexes are smaII-slightly more than 1.5 percent. These differences are much larger in the 

ages 55 years and older. Elevated serum cholesterol levels increase with age for women but 

show a slight decrease for men at ages 55 years 

and over. 

There are higher proportions of white and 

Negro women with serum cholesterol levels of 

260 mg per 100 ml and more than there are of 

Table 4. Serum cholesterol levels of adults 18-74 years by race, sex, and age with mean, standard deviation, and standard error of the 

mean: United States, 1971-74 

I White Negro 

Women I Men 

Standard Standard 

Standard kandard 

Mean 1 error of dear+ error of 

deviation Ieviation 

the mean :he mean 

All ages 

18-74 

years .. ...... 222.2 49.7 1.09 225.1 53.0 1.78

18-24 years.. 187.3 37.2 2.07 191.1 41.1 

4=4= 2.11 185.0 32.5 =4=4=

3.75 194.7 38.9
 3.33

25-34 years.. 209.9 42.4 2.38 202.8 42.4 1.47 214.2 57.0 9.26 207.3 40.7 3.42


35-44 years.. 231.5 45.5 2.49 216.4 42.8 1.56 224.7 51.7 8.56 216.9 42.2 3.25


45-54 years.. 239.9 47.4 2.61 242.5 52.5 2.49 237.1 42.2 5.61 244.7 46.5 6.49


55-64 years.. 239.9 50.6 3.41 256.4 47.8 -u_ 2.89 243.8 58.8 11.65 260.8 52.6 5.68


5-74 years.. 236.3 54.3 2.40 261.8 52.3 2.02 237.3 48.4 3.40 259.7 47.7 3.78

lMg per 100 ml. 
6 achlamedata 

e 

men in ages 18-24 and 45 years and older (table 

5). This pattern is reversed for the age groups 

25-34 and 35-44 years, when the proportions 

are higher for white and Negro men than for 

women of both races. In the age group 45-54 

years, the differences in proportions between 

white men and women are 0.6 percent while the 

differences between Negro men and women are 

11.8 percent. The differences are larger in the 

ages 55 years and older, particularly for white 

amen as compared to white women, 16.8 and 

20.5 percent, respectively. 

The proportion of white men and women 

with serum cholesterol levels of 260 mg per 100 

n-d and more in the youngest age group measured, 18-24 years, are consistently higher than 

those of their Negro counterparts (table 5). 

However, the pattern is reversed for the age 

group 25-44 years, when the proportions of serum cholesterol levels for Negro men and 

Table 5, Prevalence rates for serum cholesterol levels of 260 or more among adults 18-74 years by race, sex, and age with standard errors: 

United States, 1971-74 

Prevalence rate for serum Standard error of prevalence 

Rate ‘opulation itandard cholesterol levels of 260 rate for saru m cholesterol 

Sex and age per estimate ?rror of or morel levels of 260 or morel 

100 in rate personsl :housands 

Both sexes 

All ages 18-74 years .......... 

18-24 years .... ....... ................. 

25-34 yeara ........... ....... ......... . 

35-44 years .... .. ...................... 

45-54 years ................... ......... 

55-64 years .... ........................ 

65-74 years ............................ 

— 

Men

All ages 18-74 years .......... 

18-24 years ............................ 

25-34 years ............................ 

35-44 years ...................... ...... 

45-54 years ..... ....................... 

55-64 years ............................ 

65-74 years ............................ 

Women 

All ages 1B-74 years .......... 

18-24 years ...... ...................... 

25-34 years ...... ...................... 

35-44 years ............................ 

45-54 years ............................ 

55-64 years ...................... ...... 

65-74 years ............. ....... ........ 

White 

21.9 27,974 0.58 22.1 

4.8 1,134 0.54 4.9 

10.5 2,812 0.84 10.3 

19.3 4,353 1.22 19.2 

31.0 7,289 1.61 31.2 

38.2 7,203 2.32 38.2 

40.6 5,182 1.27 40.9 

20.4 12,358 0.87 20.6 

4.0 451 0.78 4.1 

12.1 1,538 1.46 11.7 

25.3 2,735 2.13 24.9 

30.1 3,392 2.22 30.9 

29.7 2,636 2.39 29.4 

29.2 1,605 1.38 29.2 

23.2 15,616 0.79 23.5 

5.6 683 0.87 5.6 

9.1 1,275 0.97 9.0 

13.7 1,618 1.19 13.7 

31.8 3,897 2.08 31.5 

45.9 4,567 3.04 46.2 

49.2 3,577 1.81 49.7 

Negro White Negro 

Rate per 100 parsons 

20.4 

4.0 

12.5 

18.4 

30.2 

40.3 

38.7 

19.0 

2.5 

14.9 

25.6 

24.2 

34.0 

30.3 

21.6 

5.3 

10.4 

14.1 

36.0 

44.6 

44.9 

0.60 1.300 

0.62 0.82


0.84 3.50


1.18 3.43


1.69 4.58


2.44 4.54


1.37 3.32


0.92 1.87


0.88 1.68


1.54 5.10


2.03 7.00


2.25 5.82


2.59 10.20


1.57 3.38


0.83 1.58


1.05 1.48


0.98 2.87


1.22 2.71


2.19 6.81


3.19


1.90


lMg per 100 ml. 
---

ackmedm7 

women are slightIy higher than their white 

counterparts. Consist ent findings are not found 

in the older age groups. In the age group 45-54 

years, white men and Negro women have a 

higher proportion of elevated serum cholesterol 

levels than white women and Neqo men. In contrast, in the age groups 55-64 and 65-74 years, 

Negro men and white women have a higher elevated serum cholesterol leveI than white men 

and Negro women. 

REFERENCES 

‘ National Center for Health Statistics: Plan and operation of the Health and Nutrition Examination Survey, 

United States, 1971-1973. Vital and Health Statistics. 

Series 1, No. 10a and 10b. DHEW Pub. No. (HSM) 

73-1310. Washington. U.S. Government Printing Office, 

Feb. 1973. 

‘National Center for Health Statistics: Total Serum 

Cholesterol Level of Adults, 18-74 Years of Age, United 

States, 1971-1974. Vital and Health Statistics. Series 11. 

Health Resources Administration. To be published. 

3Gordon, T., and Verter, J.I.: The Framingham 

Study: An Epidemiological Investigation of Cardiovas­

� TECHNICAL 

The samding Plan for the 65 me-selected 

examination ‘Ioc;ti&s in the Health&and Nutrition Examination Survey (HANES) followed a 

highly stratified multi-stage probability design in 

which a sample of the civilian, noninstitutionalized population of the conterminous United 

States, 1-74 years of age, was selected. Successive elements dealt with in the process of sampling were the primary sampling unit, census 

enumeration district, segment (a cluster of 

households), household, eligible person, and 

sample person. The sampIing design provided for 

over-sampling among persons living in poverty 

areas, presch;ol childr&, women of-childbearing 

age, and the eIderly. 

cuku Disease. Section 23. Serum cholesterol, systolic 

blood pressure and Framingham relative weight as discriminators of cardiovascular disease. Bethesda, Md., National Institutes of Health, 1969. 

4Abell, L.L., Levy, G. B., Brodie, B.B., and Kendall, 

F.E.: A Simplified Nfethod for the Estimation of Total 

Cholesterol in Serum and Demonstration of Its Specificity. J.Biol. Chem. 195:357, 1952. 

5 Eavenson, D., Grier, O.T., Cisson, J .G., and Witter, 

R. F.: A semiautomated procedure for the determination 

of serum cholesterol using the Abell-Kendall method. 

J.Am. Oil Chem. Sot. 43:652,1966. 

NOTES 

The serum cholesterol determinations are 

shown as population estimates, that is, the serum cholesterol findings for each individual have 

been “weighted” by the reciprocal of the probability of selecting the person. Adjustments were 

made for persons in the sample who were not 

examined and for post-stratified ratio. Adjustments were also made so that the final sampling 

estimates of the population size were brought 

into closer zdignment with the U.S. Bureau of the 

Census independent estimates for the civilian 

noninstitutionalized population of. the United 

States as of November 1, 1972, by race, sex, 

and age. 

SYMBOLS 

Data not available—-—–—––—-——————— 

Category not applicable———— —--—- . . . 

Quantity zero——-——-—-— 

Quantity more than O but less than 0.05— 0.0 

Figure does not meet standards of * reliability ar precision————— 

GPO 917-472 
8 advancedata 

Previous issues of Advance Data From Vital and Health Statistics 

No. 1. Blood Pressure of Persons 6-74 Years of Age in the United States 

(Issued: October 18, 1976) 

No. 2. Hypertension: United States, 1974 (Issued: November 8, 1976) 

No. 3. Height and Weight of .4dults 18-74 Years in the United States (Issued: November 19, 1976) 

No. 4. Prevalence of Dermatological Diseases Among Persons 1-74 Years of 

Age, United States (Issued: January 26, 1977) 

No. 5. A Comparison of Levels of 

of Age in the United States 

ary 22, 1977) 

No. 6. Dietary Intake of Persons 

(Issued: March 30, 1977) 

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