Background and methods: We assessed community trends in the awareness, treatment, and control of hypercholesterolemia (defined as a serum cholesterol level greater than 6.21 mmol per liter [240 mg per deciliter]) during the 1980s in the Minneapolis-St. Paul (Twin Cities) metropolitan area. Twin Cities residents 25 to 74 years old participated in independent, cross-sectional, population-based surveys of risk factors for cardiovascular disease in 1980-1982 (n = 3365) and 1985-1987 (n = 4545).
Results: Mean serum total cholesterol levels, as adjusted for age, decreased significantly (P less than 0.01) from 1980-1982 to 1985-1987 in men (from 5.30 mmol per liter [205 mg per deciliter] to 5.16 mmol per liter [200 mg per deciliter]) and women (from 5.19 mmol per liter [201 mg per deciliter] to 5.04 mmol per liter [195 mg per deciliter]). The prevalence of hypercholesterolemia as adjusted for age decreased significantly (P less than 0.05) in men (17.8 to 15.1 percent) and women (17.1 to 13.6 percent). The ratio of total cholesterol to high-density lipoprotein (HDL) cholesterol was unchanged during this period, because of a concurrent decline in the level of HDL cholesterol. Participants with hypercholesterolemia in the 1985-1987 survey were more likely than those in the 1980-1982 survey to be aware of their condition (32.6 vs. 25.4 percent), to be treated with lipid-lowering agents (4.3 vs. 1.9 percent), and to have their condition controlled (1.9 vs. 0.3 percent). Among those who reported treatment by a physician for hyperlipidemia, changes were observed in the type of treatment recommended. A significant increase (P less than 0.05) was noted from 1980-1982 to 1985-1987 in the percentage of men being treated for hyperlipidemia with lipid-lowering medication (5.2 vs. 11.6 percent) and with exercise programs (10.3 vs. 20.1 percent). In women being treated for hyperlipidemia, a nonsignificant increase was noted in the use of lipid-lowering medication (8.2 vs. 13.9 percent), and a significant increase (P less than 0.05) was observed in the number of exercise prescriptions (4.1 vs. 12.0 percent).
Conclusions: We found a substantial decline in the prevalence of hypercholesterolemia in the Twin Cities between 1980-1982 and 1985-1987 that may be attributed to changes in lifestyle, such as diet and exercise, and to a lesser extent to more aggressive intervention with lipid-lowering drugs by physicians.