Definitions – Cholesterol Visualizations

Diabetes:
  • Fasting plasma glucose greater than or equal to 126 mg/dl if fasting is eight hours or more, or
  • Fasting plasma glucose greater than or equal to 200 mg/dl if fasting is less than eight hours, or
  • A glycohemoglobin (A1c) level greater than or equal to 6.5% or currently taking diabetic pills or insulin to lower high blood sugar level, or
  • Ever been told by a doctor or other health professional that one has diabetes
Atherosclerotic Cardiovascular Disease (ASCVD)
Ever been told by a doctor or other health professional that one has coronary heart disease or angina/angina pectoris, or heart attack, or stroke

LDL-C
Low-density lipoprotein cholesterol

ASCVD Risk Score
An estimated 10-year atherosclerotic cardiovascular disease (ASCVD) risk was calculated using the pooled cohort equations for adults ages 40-75 years without ASCVD based on sex, age, race/ethnicity, diabetes status, smoking status, systolic blood pressure (mm Hg), use of antihypertensive medications, high-density lipoprotein cholesterol (HDL-C) level (mg/dl), and total cholesterol level (mg/dl)1. ASCVD risk calculation was performed in individuals with no prior history of coronary heart disease or angina/angina pectoris, heart attack, stroke, or heart failure.

Statin Eligible Groups
ASCVD and Age >21 years: Individuals ages 21 years and older with a history of ASCVD.

LDL-C > 190 mg/dl and Age >21 years: Individuals with estimated untreated LDL-C greater than or equal to 190 mg/dl and ages 21 years and older. Among individuals currently using statin therapy, an estimated untreated LDL-C was calculated based on multiplying treated LDL-C levels by adjustment factors for statin therapy type according to the Dutch Lipid Network criteria2.

Diabetes and Age 40-75 years: Individuals with estimated untreated LDL-C 70-189 mg/dl with diabetes and ages 40-75 years.

ASCVD Risk >7.5% and Age 40-75 years: Individuals with calculated 10-year ASCVD Risk Scores greater than or equal to 7.5% with LDL-C greater than 70 mg/dl and age 40-75 years.

Exclusion/Inclusion Criteria
Pregnant women are excluded from analyses. Participants with both interview and mobile examination centers (MEC) data were are included.

Race/Ethnicity:
Hispanic designation for race/ethnicity represents Mexican-Americans only through 2006. After a NHANES sampling redesign in 2007, Hispanic designation includes all Hispanics. More details on survey design changes and analytic note can be found here.

Non-Hispanic Asians are reported separately starting in 2011-2012. Non-Hispanic Asians were included in the “Other” category for race/ethnicity in 2009-2010 due to insufficient sample sizes.

 

Data Source and Methods

NHANES is a cross-sectional survey designed to monitor the health and nutritional status of the civilian noninstitutionalized U.S. population using highly stratified, multistage probability designs. The survey consists of interviews conducted in participants’ homes and standardized health examinations conducted in mobile examination centers (MECs).

Data from the National Health and Nutrition Examination Surveys (NHANES) 2011-2014 are used for these visualizations. For analysis of data for subpopulations, the estimates are performed using four years of data (two cycles merged) to increase statistical stability. Estimates are age-adjusted to the subpopulations based on population distributions in the 2000 Census. Appropriate sampling weights were used so that the sum of the weights added to the total U.S. population.

For more information about the National Health and Nutrition Examination Survey, you may visit the NHANES website at: http://www.cdc.gov/nhanes.

 

References
1 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk. doi: 10.1161/01.cir.0000437741.48606.98.
2Available at: http://www.athero.org.au/fh/wp-content/uploads/Supporting-Documentation-for-the-manual-calculation-of-DLCNS.pdf. Accessed November 8, 2018.