Low-Density Lipoproteins-Cholesterol Prevalence and Risk Factors: An Examination of the 2015–2016 National Health and Nutrition Examination Survey in the United States

Authors

  • Tambe E. Akem Public Health and Health Risks Expert in Fragile Settings, One Health Researcher, Field Epidemiologist MSF, Belgium
  • Marianne Cuéllar Senior Medical Information Specialist, IPSEN Biopharmaceuticals Canada Inc., Canada

Keywords:

HDL-C, Risk factors, Cardiovascular diseases, NHANES

Abstract

Background
Non-communicable diseases (NCDs) are the leading cause of mortality worldwide, with cardiovascular diseases (CVDs) being the most predominant. This is a similar trend in the United States (U.S.). Modifiable and non-modifiable factors are important determinants of dyslipidaemia, a known cause of CVDs.
Objective
This study aimed to explore the pattern of high-density lipoprotein cholesterol (HDL-C) distribution and its associated risk factors.
Methods
The data was collected from the National Health and Nutrition Examination Survey (NHANES) 2015-2016 database which is part of the yearly cross-sectional survey. The NHANES uses complex multistage probability sampling method in data collection. The target population was the noninstitutionalized civilian living across the U.S. The primary sampling units were individuals. Socio-demographic characteristics, body measurement (waist circumference) and blood samples (to determine HDL-C and total cholesterol levels) were recorded. In the database, 5000 respondents were randomly selected for analysis. Statistical analyses were performed using Stata version 14.0. The results are described as means and standard deviation (SD) for group and continuous variables. Regression analyses were used to identify risk factors of low HDL-C.
Results
Of the complete cases (3989), 49.03% were males. The mean age was 46.57±15.44-years. The mean HDL-C was 1.39±0.45 mmoL/L. The prevalence of low HDL-C was 32.8% in males and 12.5% in females. The results obtained from multiple linear regression indicated that male gender, age, ethnicity, country of birth, number of children aged 0-18-years per household, waist circumference, family income to poverty ratio and total cholesterol were significantly associated with HDL-C. Multivariable logistic regression revealed male gender, age 30 to 49-years, ethnicity, smoking, enlarged waist circumference (cm), low family income to poverty ratio and high total cholesterol were associated with low HDL-C.
Conclusion
The prevalence of low HDL-C of was 22.4 %. This was distributed into 32.8% in males and 12.5% in females. The associated risk factors show that lifestyle modification is important in the prevention of low HDL-C and consequently, CVDs.

References

Ge P, Dong C, Ren X, Weiderpass E, Zhang C, Fan H, et al. The high prevalence of low HDL-cholesterol levels and dyslipidemia in rural populations in Northwestern China. PLoS One. 2015; 10(12): e0144104. doi: 10.1371/journal.pone.0144104

Carroll MD, Fryar CD, Nguyen DT. High Total and Low High-Den-sity Lipoprotein Cholesterol in Adults: United States, 2015–2016. NCHS Data Brief, no 290. Hyattsville, MD, USA: National Center for Health Statistics; 2017.

Mainous AG, Tanner RJ, Jo A, Park K, De Rochars VMB. Trends in cardiovascular disease risk in the U.S., 1999-2014. Am J Prev Med. 2018; 55(3): 384-88. doi: 10.1016/j.amepre.2018.04.025

Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third re-port of the National Cholesterol Education Program (NCEP) ex-pert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA. 2001; 285(19): 2486-2497. doi: 10.1001/jama.285.19.2486

Alberti KGMM, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: A joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and Internation-al Associationfor the Study of Obesity. Circulation. 2009; 120(16): 1640-1645. doi: 10.1161/CIRCULATIONAHA.109.192644

Cox RA, García-Palmieri MR. Cholesterol, triglycerides, and associated lipoproteins. In: Walker HK, Hall WD, Hurst JW, eds. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd ed. Boston, USA: Butterworths; 1990.

Willey JZ, Rodriguez CJ, Carlino RF, Moon YP, Paik MC, Boden-Albala B, et al. Race-ethnic differences in the association between lipid profile components and risk of myocardial infarc-tion: The Northern Manhattan Study. Am Heart J. 2011; 161(5): 886-892. doi: 10.1016/j.ahj.2011.01.018

Brownson RC, Boehmer TK, Luke DA. Declining rates of physical activity in the United States: What are the contributors? Annu Rev Public Health. 2005; 26: 421-443. doi: 10.1146/annurev. publhealth.26.021304.144437 Submit your article to this journal | https://openventio.org/submit-manuscript/ Akem TE et al

Aguilar-Salinas CA, Olaiz G, Valles V, Torres JM, Gómez Pérez FJ, Rull JA, et al. High prevalence of low HDL cholesterol con-centrations and mixed hyperlipidemia in a Mexican nationwide survey. J Lipid Res. 2001; 42: 1298-1307. doi: 10.1016/S0022- 2275(20)31581-9

Jansen H, Verhoeven AJ, Sijbrands EJ. Hepatic lipase a pro-or anti-atherogenic protein? J Lipid Res. 2002; 43: 1352-1362. doi: 10.1194/jlr.r200008-jlr200

Vaidya D. Sex hormones and circulating lipoprotein levels. Fu-ture Lipidology. 2008; 3: 603-606. doi: 10.2217/17460875.3.6.603

Gonzalez C, Stern MP, Gonzalez E, Rivera D, Simon J, Islas S, et al. The Mexico City Diabetes Study: A population-based ap-proach to the study of genetic and environmental interactions in the pathogenesis of obesity and diabetes. Nutr Rev. 1999; 57: S71-S76. doi: 10.1111/j.1753-4887.1999.tb01792.x

Winkleby MA, Robinson TN, Sundquist J, Kraemer HC. Eth-nic variation in cardiovascular disease risk factors among children and young adults: Findings from the Third National Health and Nutrition Examination Survey, 1988-1994. 1999; 281(11): 1006- 1013. doi: 10.1001/jama.281.11.1006

Chang HC, Hsieh CF, Tantoh DM, Ko P-C, Kung Y-Y, Lin M-C, et al. HDL and associated factors stratified by sex and menopausal status: results from a community-based survey in Taiwan. Oncotar-get. 2018; 9(23): 16354-16367. doi: 10.18632/oncotarget.24677

Kim SM, Han JH, Park HS. Prevalence of low HDL-cholester-ol levels and associated factors among Koreans. Circ J. 2006; 70(7): 820-826. doi: 10.1253/circj.70.820

Cheung BM, Li M, Ong KL, Wat NM, Tam S, Pang RW, et al. High density lipoprotein-cholesterol levels increase with age in American women but not in Hong Kong Chinese wom-en. Clin Endocrinol (Oxf). 2009; 70: 561-568. doi: 10.1111/j.1365- 2265.2008.03361.x

Harman JL, Griswold ME, Jeffries NO, Sumner AE, Sar-pong DF, Akylbekova EL, et al. Age is positively associated with high-density lipoprotein cholesterol among African Americans in cross-sectional analysis: The Jackson Heart Study. J Clin Lipidol. 2011; 5(3): 173-178. doi: 10.1016/j.jacl.2011.02.002

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Published

2025-07-03

How to Cite

Tambe E. Akem, & Marianne Cuéllar. (2025). Low-Density Lipoproteins-Cholesterol Prevalence and Risk Factors: An Examination of the 2015–2016 National Health and Nutrition Examination Survey in the United States. Public Health - Open Journal, 10(2), 19–29. Retrieved from https://openventio.us/index.php/PHOJ/article/view/2326