Overlapping pattern of the four individual components of dyslipidemia in adults: analysis of nationwide cross-sectional data

Abstract

Abstract Background Dyslipidemia, including abnormalities in any one of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), and high-density lipoprotein cholesterol (HDL-C) is a well-recognized risk factor for cardiovascular disease (CVD). However, among the currently available drug treatments, only the ones that lower LDL-C and consequently TC have proven effective in preventing CVD, suggesting that people with isolated high TG or low HDL-C would unlikely benefit from the treatments. The study aimed to investigate the overlapping pattern of the four individual components of dyslipidemia in adults, which could provide benchmark estimates on the contribution of each component to dyslipidemia prevalence and consequently on the proportion of potential beneficiaries of currently available, effective lipid-lowering drugs that are targeted at high LDL-C and high TC. Methods We included 7,822 participants aged ≥ 20 years, abnormal in any of the four lipid parameters, and not on lipid-lowering medications, from the National Health and Nutrition Examination Survey cycle 1999–2000 through cycle 2017–2018. Dyslipidemia was defined as presence of at least one of the following: TC ≥ 240 mg/dL, LDL-C ≥ 160 mg/dL, HDL-C < 40 mg/dL in males or < 50 mg/dL in females, and TG ≥ 200 mg/dL. The proportions of different combinations of them were calculated and then presented using area-proportional Euler plots. Results High TC, high LDL-C, high TG, and low HDL-C were seen in 32.8%, 28.1%, 26.7%, and 65.9% of the people with dyslipidemia, respectively. “High LDL-C or high TC”, “normal LDL-C, normal TC, but high TG”, and “normal LDL-C, normal TC, normal TG, but low HDL-C” (isolated low HDL-C) accounted for 37.5%, 18.3%, and 44.2% of dyslipidemia, respectively. “High LDL-C or high TC” accounted for 54% of dyslipidemia in those aged ≥ 60 years, while isolated low HDL-C was the most prevalent abnormality in almost all the other subgroups defined by gender, age and race. Conclusions Isolated low HDL-C, which was unlikely to benefit from currently available, effective drug treatments targeted at high LDL-C or TC, was the largest contributor to dyslipidemia prevalence. Potential beneficiaries of currently available drugs, i.e., those with high LDL-C or TC, accounted for 37.5% of all people with dyslipidemia.