High Cholesterol in United States

United States

High cholesterol is a major and modifiable risk factor for heart disease and stroke, the leading and fifth-leading causes of death in the United States, respectively. Excess low-density lipoprotein cholesterol (also known as LDL or “bad” cholesterol) creates a plaque that narrows arteries and reduces oxygen-rich blood flow. When a coronary artery is blocked and the heart cannot get enough oxygen, the result is a heart attack. Similarly, restricted blood flow to the brain can cause a stroke. An estimated 24.7 million U.S. adults have high total cholesterol (≥ 240 mg/dL). 

High cholesterol is influenced by modifiable risk factors like poor diet (eating foods high in saturated fat and cholesterol), overweight and obesity, physical inactivity and smoking.

According to America’s Health Rankings data, the prevalence of high cholesterol is higher among:

• Men than women.
• Adults ages 65 and older compared with adults ages 18-44. 
• Non-Hispanic white adults and adults who identify their race as other compared with Hispanic adults.
• Adults with less than a high school education compared with college graduates. 
• Adults with an annual household income less than $25,000 compared with those with higher income levels.
• Adults living in non-metropolitan areas compared with adults in metropolitan areas.

High cholesterol is an ideal target for prevention and control strategies because it is a modifiable risk factor for heart disease and stroke and can be managed through therapeutic lifestyle changes and health care interventions, including: 

• Increasing physical activity.
• Quitting smoking.
• Managing weight.
• Eating healthy foods. A diet low in saturated fats has been identified by the 2020-2025 Dietary Guidelines as one of the most effective lifestyle changes to decrease high cholesterol. The guidelines specifically recommend eating vegetables, beans, seafood, whole grains and nuts while avoiding solid fats, added sugars, refined grains and red meat. 
• Using cholesterol-lowering medications, which have contributed to a substantial decrease in the prevalence of high cholesterol over the past 25 years. 

In order to identify high cholesterol, which usually has no signs or symptoms, the American Heart Association recommends adults ages 20 and older have their cholesterol checked with a blood test every four to six years.

Healthy People 2030 has many objectives related to heart disease and stroke, including:

• Reducing cholesterol levels in adults.
• Increasing cholesterol treatment in adults

Kuklina, Elena V., Margaret D. Carroll, Kate M. Shaw, and Rosemarie Hirsch. “Trends in High LDL Cholesterol, Cholesterol-Lowering Medication Use, and Dietary Saturated-Fat Intake: United States, 1976-2010.” NCHS Data Brief No. 117. Hyattsville, MD: National Center for Health Statistics, March 2013. https://www.cdc.gov/nchs/products/databriefs/db117.htm/.

Tsao, Connie W., Aaron W. Aday, Zaid I. Almarzooq, Cheryl A.M. Anderson, Pankaj Arora, Christy L. Avery, Carissa M. Baker-Smith, et al. “Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association.” Circulation 147, no. 8 (February 21, 2023). https://doi.org/10.1161/CIR.0000000000001123.

U.S. Department of Agriculture and U.S. Department of Health and Human Services. “Dietary Guidelines for Americans, 2020-2025.” Washington, D.C.: U.S. Department of Agriculture and U.S. Department of Health and Human Services, December 2020. https://www.dietaryguidelines.gov/sites/default/files/2020-12/Dietary_Guidelines_for_Americans_2020-2025.pdf.