NCHS Data Brief ■ No. 92 ■ April 2012

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Total and High-density Lipoprotein Cholesterol in Adults: 

National Health and Nutrition Examination Survey,

 2009–2010

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

High total cholesterol and low high-density lipoprotein (HDL) cholesterol 

are major risk factors for coronary heart disease, including heart attacks 

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

disease, the Adult Treatment Panel of the National Cholesterol Education 

Program recommends that adults be screened for cholesterol (6). This report 

presents the most recent prevalence estimates of high total cholesterol, low 

HDL cholesterol, and cholesterol screening. Trends over the last 12 years for 

high total cholesterol are also presented. Analysis is based only on measured 

cholesterol and does not take into account whether medications are taken.

Keywords: cholesterol screening • high total cholesterol • low high-density 

lipoprotein cholesterol • National Health and Nutrition Examination Survey

What percentage of adults aged 20 and over had high total 

cholesterol during 2009–2010? 

An estimated 13.4% of adults aged 20 and over had high total cholesterol in 

2009–2010 (Figure 1). The percentage with high total cholesterol was higher 

Key findings

Data from the National 

Health and Nutrition 

Examination Survey, 

2009–2010 

•	 Just over 13% of U.S. adults 

had high total cholesterol, 

meeting the Healthy People 

2010 objective of 17% or 

less for high total cholesterol. 

However, the objective was not 

achieved by women aged 40 

and over.

•	 From 1999 through 2010, 

the percentage of adults aged 

20 and over with high total 

cholesterol declined by 

27 percent.

•	 Approximately 12% of 

women and 31% of men had 

low high-density lipoprotein 

cholesterol in the 2009–2010 

survey. 

•	 Overall, more than twothirds of adults were screened 

for cholesterol in the preceding 

5 years. However, screening 

rates ranged from 71% in nonHispanic white women to 50% 

in Hispanic men. Hispanic men 

are less likely to be screened 

than non-Hispanic white or 

non-Hispanic black men.

1

Significantly different from non-Hispanic black population.

2

Significantly different from non-Hispanic white population.

3

Significantly different from men in the same racial and ethnic group.

NOTES: High total cholesterol is serum total cholesterol equal to or greater than 240 mg/dL. Estimates were age adjusted by the 

direct method to U.S. Census 2000 population estimates using age groups 20–39, 40–59, and 60 and over.

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

Figure 1. Percentage of adults aged 20 and over with high total cholesterol, by sex and race 

and ethnicity: United States, 2009–2010 Percent

0

5

10

15

20

25

30

Total Men Women

13.4 12.2 11.4 10.2 10.3

13.5 13.2

10.3

1

14.5 1,2

15.4 3

14.3 3

15.4

Non-Hispanic Hispanic

black

Non-Hispanic 

white

All race and

ethnicity groups
NCHS Data Brief ■ No. 92 ■ April 2012

■  2  ■

in women (14.3%) than in men (12.2%) and in non-Hispanic white women (15.4%) than in 

non-Hispanic white men (11.4%).

A larger percentage of Hispanic men had high total cholesterol (15.4%) compared with both 

non-Hispanic white (11.4%) and non-Hispanic black men (10.2%). 

Did the percentage of adults with high total cholesterol change between 

1999 and 2010?

During 1999–2010, a decreasing trend was observed in the percentage of adults with high 

total cholesterol (Figure 2). For 1999–2000, 18.3% had high total cholesterol, whereas for 

2009–2010, 13.4% had high total cholesterol. Over the 1999–2010 period, men and women 

showed a decreasing trend in high total cholesterol: 17.2% for men in 1999–2000 compared with 

12.2% in 2009–2010, and 19.1% for women in 1999–2000 compared with 14.3% in 2009–2010.

1

Significant decreasing trend (p < 0.005). 2

Healthy People 2010 Objective (12–14). 

NOTES: High total cholesterol is serum total cholesterol level equal to or greater than 240 mg/dL. Estimates were age adjusted by the direct method to U.S. 

Census 2000 population estimates using age groups 20–39, 40–59, and 60 and over. Access data table for Figure 2 at: 

http://www.cdc.gov/nchs/data/databriefs/db92_tables.pdf#2.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Surveys, 1999–2010.

Figure 2. Trends in percentage of adults aged 20 and over with high total cholesterol: United States, 1999–2010 Percent

Survey period

0

5

10

15

20

25

30

Women1

Men

1999–2000 2001–2002 2003–2004 2005–2006 2007–2008 2009–2010

HP 2010

target:

17%2
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Did trends in high total cholesterol differ by sex and age?

Among adults aged 40–59, a decreasing trend was observed in the percentage of men with high 

total cholesterol during 1999–2010, but not for women (Figure 3). For men, the percentage with 

high total cholesterol declined from 24.8% for 1999–2000 to 16.7% for 2009–2010.

For adults aged 60 and over, a decreasing trend in high total cholesterol was observed in both 

men and women, with women having consistently higher percentages of high total cholesterol 

than men.

1

Significant decreasing trends (p < 0.005). 2

Healthy People 2010 Objective (12–14). 

NOTE: High total cholesterol is serum total cholesterol equal to or greater than 240 mg/dL. Access data table for Figure 3 at: 

http://www.cdc.gov/nchs/data/databriefs/db92_tables.pdf#3. 

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 1999–2010.

Figure 3. Trends in percentage of adults aged 40–59 and 60 and over with high total cholesterol: United States, 

1999–2010 Percent

Survey period Survey period

Aged 40–59 Aged 60 and over

0

5

10

15

20

25

30

35

Women

Men1

2009–

2010

2007–

2008

2005–

2006

2003–

2004

2001–

2002

1999–

2000

HP2010 target: 17%2

0

5

10

15

20

25

30

35

Women1

Men1

2009–

2010

2007–

2008

2005–

2006

2003–

2004

2001–

2002

1999–

2000

HP2010 target: 17%2
NCHS Data Brief ■ No. 92 ■ April 2012

■  4  ■

What percentage of adults had low HDL cholesterol in 2009–2010? 

For 2009–2010, 21.3% of adults aged 20 and over had low HDL cholesterol (less than 40 mg/dL) 

(Figure 4). The percentage of adults with low HDL cholesterol was higher for men (31.4%) than 

for women (11.9%). Percentages among men were also higher than those among women 

of the same racial and ethnic group. For men, the percentage with low HDL cholesterol was 

lower among non-Hispanic black men than non-Hispanic white or Hispanic men. No racial or 

ethnic differences were found among women in the percentage with low HDL cholesterol.

1

Significantly different from non-Hispanic white population.

2

Significantly different from non-Hispanic black population.

3

Significantly different from men in each racial and ethnic group.

NOTES: Low HDL cholesterol is serum high-density lipoprotein (HDL) cholesterol less than 40 mg/dL. Estimates were age adjusted by the direct method to 

U.S. Census 2000 population estimates using age groups 20–39, 40–59, and 60 and over.

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

Figure 4. Percentage of adults aged 20 and over with low HDL cholesterol, by sex and race and ethnicity: 

United States, 2009–2010 Percent

0

5

10

15

20

25

30

35

40 All race and ethnicity groups Non-Hispanic white Non-Hispanic black Hispanic

Women Men 3 Total

21.3

31.4 31.9

21.3

1

16.4

1

20.7

2

24.8

2

35.1

11.9 11.0

12.9

14.6
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What percentage of adults had their cholesterol checked within the 

previous 5 years? 

For 2009–2010, approximately 68.0% of adults aged 20 and over had their cholesterol checked 

within the preceding 5 years (Figure 5), including almost two-thirds of men (65.6%) and 70.0% 

of women. For both men and women, non-Hispanic white persons were more likely to have had 

their cholesterol checked within the past 5 years than Hispanic persons. Non-Hispanic white men 

were more likely to have been screened than non-Hispanic black men, who themselves were more 

likely to have been screened than Hispanic men. No difference in screening levels was observed 

between non-Hispanic white and non-Hispanic black women, nor between non-Hispanic black 

women and Hispanic women.

1

Significantly different from non-Hispanic white.

2

Significantly different from non-Hispanic black.

3

Significantly different from men in the same racial and ethnic group.

NOTE: Estimates age adjusted by the direct method to the 2000 Census population using the age groups 20–39, 40–59, and 60 and over.

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

Figure 5. Percentage of adults aged 20 and over who had cholesterol checked within past 5 years, by sex and race and 

ethnicity: United States, 2009–2010 Percent

0

20

40

60

80

100

Total Men Women

67.9 65.6

70.5 70.0 1

66.1 1

61.8

1,256.0

1,249.7

3

70.0 71.0 3

69.7

1,362.6

All race and ethnicity groups Non-Hispanic white Non-Hispanic black Hispanic
NCHS Data Brief ■ No. 92 ■ April 2012

■  6  ■

Summary

The percentage of adults aged 20 and over with high total cholesterol has declined substantially 

since 1999–2000. For 2009–2010, the percentage of adults with high total cholesterol was 13.4%, 

thus meeting the Healthy People 2010 target of 17% or less [Objective (12–14)] (7). Substantial 

and steady decreases in the prevalence of high total cholesterol among men aged 40 and over and 

women aged 60 and over during the 1999–2010 period resulted in achievement of the Healthy 

People 2010 objective in all sex and racial-and-ethnic groups and in all sex and age groups except 

for women aged 40 and over.

For 2009–2010, only 11.9% of women compared with 31.4% of men aged 20 and over had low 

HDL cholesterol. The percentage with low HDL cholesterol is consistently higher in men than 

in women within each race and ethnicity group. Because women typically have higher HDL 

cholesterol levels than men (6), the percentage with low HDL cholesterol is expected to be lower 

in women than in men. The percentage of adult men with low HDL cholesterol is lower in nonHispanic black men than in Hispanic or non-Hispanic white men. 

During 2009–2010, approximately 68% of adults—including 66% of men and 70% of women—

had their cholesterol checked within the past 5 years. These percentages have not changed 

significantly from 2005–2006, when 65% of men and 71% of women had their cholesterol

checked within the past 5 years (8). Furthermore, the Healthy People 2010 objective for 

cholesterol screening of at least 80% [Objective (12–15)] (7) was not met. Less than one-half of 

Hispanic men were screened within the past 5 years compared with 70% of non-Hispanic white 

men and nearly 62% of non-Hispanic black men.

Among U.S. adults in 2009–2010, those with adverse concentrations of total cholesterol (15%) 

and HDL cholesterol (25%) are at risk for coronary heart disease, including heart attacks. The 

U.S. Department of Health and Human Services recently announced the Million Hearts Initiative 

(9) with a goal of preventing 1 million heart attacks and strokes over the next 5 years. High 

cholesterol is one major risk factor for heart attacks.

Definitions

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

Low high-density lipoprotein (HDL) cholesterol: Serum high-density lipoprotein cholesterol less 

than 40 mg/dL (6).

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 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 2010 Objective (12–14): Reduce the proportion of adults with high total blood 

cholesterol levels. Target: 17% (7).

Healthy People 2010 Objective (12–15): Increase the proportion of adults who have had their 

blood cholesterol checked within the preceding 5 years. Target: 80% (7).
NCHS Data Brief ■ No. 92 ■ April 2012

■  7  ■

Data source and methods

Data from National Health and Nutrition Examination Surveys (NHANES) conducted from 

1999 through 2010 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 

(10). The survey consists of interviews conducted in participants’ homes; standardized physical 

examinations conducted in mobile examination centers; and laboratory tests utilizing blood 

specimens provided by participants during the physical examination. Details on the laboratory 

methods are available elsewhere (10).

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

year 2009–2010, non-Hispanic black and Hispanic persons, persons with low income, 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.

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 by using Taylor series linearization. 

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

the U.S. Census 2000 population using age groups 20–39, 40–59, and 60 and over. For NHANES 

2009–2010, a total of 4,119 interviewed adults reported they had their cholesterol checked within 

the past 5 years; 5,696 examined adults had data for serum total and HDL cholesterol. Differences 

between groups were tested using a t statistic with the appropriate number of degrees of freedom 

at the p < 0.05 significance level. Linear survey trends were tested using orthogonal contrast

matrices. All differences reported are statistically significant unless otherwise indicated. The

Bonforroni method was used to adjust for multiple comparisons by dividing the overall α level

of 0.05 by the number of implied comparisons. To test for race and ethnicity differences for men 

and for women, three implied comparisons were used. Statistical analyses were conducted using 

the SAS System for Windows (release 9.2; SAS Institute Inc., Cary, N.C.) and SUDAAN (release 

10.0; RTI International, Research Triangle Park, N.C.).

About the authors

Margaret D. Carroll, Brian K. Kit, and David A. Lacher are with the Centers for Disease 

Control and Prevention’s National Center for Health Statistics, Division of Health and Nutrition 

Examination Surveys. 

References

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coronary heart disease using risk factor categories. Circulation 97(18):1837–47. 1998.

2. Lipid Research Clinics Program. The Lipid Research Clinics Coronary Primary Prevention 

Trial results II: The relationship of reduction in incidence of coronary heart disease to cholesterol 

lowering. JAMA 251(3):365–74. 1984.
NCHS Data Brief ■ No. 92 ■ April 2012

3. Stamler J, Wentworth D, Neaton JD. Is the relationship between 

serum cholesterol and risk of premature death from coronary heart disease 

continuous and graded? Findings in 356 222 primary screenees of the Multiple 

Risk Factor Intervention Trial (MRFIT). JAMA 256(20):2823–8. 1986.

4. Wilson PW, Garrison RJ, Castelli WP, Feinleib M, McNamara PM, 

Kannel WB. Prevalence of coronary heart disease in the Framingham 

Offspring Study: Role of lipoprotein cholesterols. Am J Cardiol 46(4): 

649–54. 1980.

5. Assmann G, Schulte H, von Eckardstein A, Huang Y. High-density 

lipoprotein cholesterol as a predictor of coronary heart disease risk: The 

PROCAM experience and pathophysiological implications for reverse 

cholesterol transport. Athrosclerosis 124(Suppl):S11–20. 1996. 

6. National Institutes of Health, National Heart, Lung and Blood Institute. 

Third report of the National Cholesterol Education Program (NCEP) 

Expert Panel on Detection, Evaluation and Treatment of High Blood 

Cholesterol in Adults (Adult Treatment Panel III): Final report. 

NIH Publication No. 02–5215. 2002.

7. U.S. Department of Health and Human Services. Healthy People 2010. 

2nd ed. 2 vols. Washington, DC: U.S. Government Printing Office. 2000.

8. 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.

9. U.S. Department of Health and Human Services. Million Hearts 

Initiative. Available from: http://millionhearts.hhs.gov/index.shtml. 

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

Examination Survey, NHANES 2009–2010. Available from: 

http://www.cdc.gov/nchs/nhanes/nhanes2009-2010/nhanes09_10.htm.

Suggested citation

Carroll MD, Kit BK, Lacher DA. Total 

and high-density lipoprotein cholesterol in 

adults, 2009–2010. NCHS data brief no 92. 

Hyattsville, MD: National Center for Health 

Statistics. 2012.

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

Clifford L. Johnson, M.S.P.H., Director

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