NCHS Data Brief ■ No. 177 ■ December 2014

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Prescription Cholesterol-lowering Medication Use in Adults 

Aged 40 and Over: United States, 2003–2012

Qiuping Gu, M.D., Ph.D.; Ryne Paulose-Ram, Ph.D., M.A.; Vicki L. Burt, Sc.M., R.N.; 

and Brian K. Kit, M.D., M.P.H.

Key findings

Data from the National 

Health and Nutrition 

Examination Survey

● During 2003–2012, the 

percentage of adults aged 40 

and over using a cholesterollowering medication in the past 

30 days increased from 20% to 

28%.

● The use of statins increased 

from 18% to 26%. By 

2011–2012, 93% of adults 

using a cholesterol-lowering 

medication used a statin.

● Cholesterol-lowering 

medication use increased with 

age, from 17% of adults aged 

40–59 to 48% of adults aged 75 

and over. 

● About 71% of adults 

with cardiovascular disease 

and 54% of adults with 

hypercholesterolemia used 

a cholesterol-lowering 

medication. 

● Adults aged 40–64 with 

health insurance were more 

likely than those without health 

insurance to use a cholesterollowering medication.

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality 

in the United States. Nearly one in three Americans dies of heart disease or 

stroke (1). Elevated blood cholesterol is a major risk factor for CVD, and statin 

therapy has been strongly associated with a reduced risk of atherosclerotic 

CVD (2,3). The national cholesterol treatment guidelines outline the 

importance of using cholesterol-lowering medications for the prevention of 

coronary heart disease (4). Using National Health and Nutrition Examination 

Survey (NHANES) data, this report evaluates recent trends in prescription 

cholesterol-lowering medication use among U.S. adults aged 40 and over.

Keywords: prevalence • statins • trends • NHANES

What were the trends in prescription cholesterol-lowering 

medication use in the United States?

During 2011–2012, more than one-quarter (27.9%) of adults aged 40 and over 

reported using a prescription cholesterol-lowering medication in the past 30 days. 

Figure 1. Percentage of adults aged 40 and over who reported using a prescription cholesterollowering medication: United States, 2003–2012

1

Significant linear trend (p < 0.01).

NOTE: Age-adjusted by direct method to the year 2000 projected U.S. population.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2003–2012.

Nonstatin alone Statin and nonstatin

Statin alone

All cholesterol-lowering

medications

0

10

Percent

20

30

2007–2008 2009–2010 2011–2012

Survey years

2003–2004 2005–2006

19.9

23.4

26.5 27.4 1

27.9

16.3

18.4 18.9

21.4

1

23.2

2.0 3.1

5.0 4.0

2.7

2.0 1.9 2.6 1.5 1.9
NCHS Data Brief ■ No. 177 ■ December 2014

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This was an increase from 2003–2004, when one in five adults used a cholesterol-lowering 

medication (19.9%) (Figure 1).

For 2011–2012, 83% of adults who used a cholesterol-lowering medication reported using a statin 

alone, 10% used both a statin and a nonstatin, and 7% used only a nonstatin. The percentage of 

adults who used a statin alone increased from 16.3% in 2003–2004 to 23.2% in 2011–2012.

What were the most commonly used prescription cholesterol-lowering 

medications?

Among adults who used a prescription cholesterol-lowering medication, simvastatin was the most 

commonly used cholesterol-lowering medication, with 42% reporting its use. This was followed 

by atorvastatin (20.2%), pravastatin (11.2%), rosuvastatin (8.2%), and lovastatin (7.4%) (Figure 2). 

Figure 2. Percentage of adults aged 40 and over using each specific medication among those who reported using a 

cholesterol-lowering medication in the past 30 days: United States, 2011–2012 Percent

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

0

10

20

30

40

50

Pravastatin Rosuvastatin Lovastatin

Generic drug name

Simvastatin Atorvastatin

42.0

20.2

11.2

8.2 7.4
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Did prescription cholesterol-lowering medication use vary by demographic 

subgroups?

Prescription cholesterol-lowering medication use increased with age, from 17.4% in adults 

aged 40–59 to 43.3% in adults aged 60–74 and 47.6% in adults aged 75 and over. There was no 

significant difference between men (30.1%) and women (26.2%) or any race and Hispanic origin 

groups (24.1%–28.9%) in the percentage that used a prescription cholesterol-lowering medication 

(Figure 3). 

Figure 3. Percentage of adults aged 40 and over who used a prescription cholesterol-lowering medication in the past 

30 days, by age, sex, and race and Hispanic origin: United States, 2011–2012 Percent

1

Significant linear trend (p < 0.01). 2

Age-adjusted by direct method to the year 2000 projected U.S. population.

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

Sex2 Race and Hispanic origin Age 2

0

10

20

30

40

50

Black Asian Hispanic

Non-Hispanic

75 and Men Women White

over

40–59 60–74

1

47.6

30.1

26.2

28.3 28.2 28.9

24.1

17.4

43.3
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What percentage of adults with a selected medical condition used a 

prescription cholesterol-lowering medication?

Slightly more than 70% of adults with doctor-diagnosed CVD reported taking prescription 

cholesterol-lowering medication in the past 30 days. Nearly 63% of adults with diagnosed 

diabetes and nearly 54% of adults with diagnosed hypercholesterolemia reported using a 

prescription cholesterol-lowering medication (Figure 4).

Figure 4. Percentage of adults aged 40 and over who used a prescription cholesterol-lowering medication in the past 

30 days, by selected medical conditions: United States, 2011–2012 Percent

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

0

20

40

60

80

62.8

53.9

Cardiovascular disease Diabetes Hypercholesterolemia

70.8
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Did use of a prescription cholesterol-lowering medication vary among 

adults aged 40–64 with and without health insurance coverage?

Cholesterol-lowering medication use was three times greater among adults aged 40–64 with 

health insurance (23.9%) than among those without health insurance (8.1%).

Among adults aged 40–64 with a prescription drug benefit, 24.3% used a cholesterol-lowering 

medication compared with 9.3% of those who did not have a prescription drug benefit (Figure 5). 

Figure 5. Percentage of adults aged 40–64 who used a prescription cholesterol-lowering medication in the past 30 days, 

by health insurance coverage: United States, 2011–2012 Percent

1

Significantly different from the “No” group (p < 0.01).

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

0

5

10

15

20

25

30

Have health insurance Have prescription coverage

1

23.9

8.1

1

24.3

9.3

Yes No

Summary

During 2003–2012, there was a significant increase in the percentage of adults aged 40 and 

over who used a prescription cholesterol-lowering medication. In 2003–2004, one in five 

adults reported using a prescription cholesterol-lowering medication in the past 30 days. By 

2011–2012, that number had risen to one in four adults. In 2011–2012, the majority of adults using 

a cholesterol-lowering medication reported using a statin alone (83%). Ten percent used both a 

statin and a nonstatin and another 7% used only a nonstatin. Simvastatin was the most commonly 

used medication, with 42% of all cholesterol-lowering medication users reporting its use, 

followed by atorvastatin (20.2%). 

Use of a prescription cholesterol-lowering medication increased with age but was similar between 

men and women and race and Hispanic origin groups. Adults aged 40–64 who reported having 
NCHS Data Brief ■ No. 177 ■ December 2014

■  6  ■

health insurance or prescription medication coverage were more likely to take prescription 

cholesterol-lowering medications. 

Hypercholesterolemia or high cholesterol is one of the most common preventable risk factors for 

atherosclerotic CVD. In 2011–2012, more than 30 million Americans aged 20 and over (13%) 

had measured high total cholesterol (5). There is extensive and consistent evidence supporting the 

use of cholesterol-lowering medication, especially statins, in addition to lifestyle changes, to treat 

lipid disorders and reduce atherosclerotic CVD events. The 2013 cholesterol treatment guidelines 

updated recommendations for statin therapy on the basis of low-density lipid cholesterol levels 

and atherosclerotic CVD risks (6). Approximately 71% of adults with diagnosed CVD, 63% of 

those with diagnosed diabetes, and 54% of those with diagnosed hypercholesterolemia reported 

taking prescription cholesterol-lowering medications. 

Definitions

Prescription medication use: Survey participants were asked if they had taken a prescription 

medication in the past 30 days. Those who answered “yes” were asked to show the interviewer 

the medication containers of all prescription medications. For each drug reported, the interviewer 

recorded the product’s complete name from the container (7). 

Cholesterol-lowering medication: Prescription medications were classified based on the threelevel nested therapeutic classification scheme of Cerner Multum’s Lexicon (8). Cholesterollowering medications were identified using the secondary level of drug category codes, 

specifically code 19. Another prescription drug, omega-3-polyunsaturated fatty acid (brand name 

Lovaza or Omacor), was also considered a cholesterol-lowering medication. 

Statins and nonstatins: The third level of drug category codes were used to identify statins 

(code 173); nonstatins (codes 174, 241, 252, and 316); and combinations of the two (code 317). 

Omega-3-polyunsaturated fatty acid was included in the nonstatin subclass. Persons who reported 

taking both a statin and a nonstatin either in a single pill combination or two separate pills were 

considered statin and nonstatin users.

Health insurance coverage: Based on the question, “Are you covered by health insurance or some 

other kind of health care plan?”

Prescription drug benefit: Based on the question, “Do any of these plans cover any part of the cost 

of prescriptions?” 

Diagnosed cardiovascular disease: Based on an affirmative response to any one of four questions 

about doctor-diagnosed heart attack, angina, coronary heart disease, and stroke.

Diagnosed diabetes: Based on an affirmative response to the question, “Have you ever been told 

by a doctor or other health professional that you have diabetes?”

Diagnosed hypercholesterolemia: Based on an affirmative response to the question, “Have you 

ever been told by a doctor or other health professional that your blood cholesterol level was 

high?”
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Data source and methods

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. Data from NHANES 

2003–2004 through 2011–2012 were used for trend analysis, and the most recent cycle of 

2011–2012 data were further used for examining the patterns of cholesterol-lowering medication 

use.

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.

Sample weights, accounting for the differential probabilities of selection, nonresponse, and 

noncoverage, were used for analyses. Variance estimates accounted for the complex survey 

design using Taylor series linearization. Estimates for the total adult population aged 40 and over, 

for men and women, and for race and Hispanic origin subpopulations were age-adjusted by the 

direct method to the 2000 U.S. census population, using age groups 40–59, 60–74, and 75 and 

over (10). Differences between groups were evaluated using a t statistic at the p less than 0.01 

significance level (adjusted for multiple comparisons). All differences reported are statistically 

significant unless otherwise noted. To test for linear trends, the null hypothesis of nonlinear 

trend was examined using orthogonal polynomials. Statistical analyses were conducted using 

SAS version 9.3 (SAS Institute, Inc., Cary, N.C.) and SUDAAN version 11.0 (RTI International, 

Research Triangle Park, N.C.).

About the authors

Qiuping Gu, Ryne Paulose-Ram, Vicki L. Burt, and Brian K. Kit are with CDC’s National Center 

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

References

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NCHS Data Brief ■ No. 177 ■ December 2014

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5. 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. 

6. Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum 

CB, Eckel RH, et al. 2013 ACC/AHA guideline on the treatment of blood 

cholesterol to reduce atherosclerotic cardiovascular risk in adults: A report of 

the American College of Cardiology/American Heart Association Task Force 

on Practice Guidelines. Circulation 129(25 Suppl 2):S1–45. 2014.

7. National Center for Health Statistics. National Health and Nutrition 

Examination Survey. Dietary supplements and prescription medication 

questions. Available from: http://www.cdc.gov/nchs/data/nhanes/

nhanes_11_12/dsq.pdf.

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Examination Survey. 1988–2012 data documentation, codebook, and 

frequencies: Prescription medications–drug information. Available from: 

http://wwwn.cdc.gov/nchs/nhanes/1999-2000/RXQ_DRUG.htm.

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Examination Survey. Available from: http://www.cdc.gov/nchs/nhanes.htm.

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Suggested citation

Gu Q, Paulose-Ram R, Burt VL, Kit 

BK. Prescription cholesterol-lowering 

medication use in adults aged 40 and over: 

United States, 2003–2012. NCHS data brief, 

no 177. Hyattsville, MD: National Center 

for Health Statistics. 2014.

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., M.B.A., 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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