Residual dyslipidemia according to low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, and apolipoprotein B among statin-treated US adults: National Health and Nutrition Examination Survey 2009-2010

- Of US adults aged ≥18 years on statin-based therapy, 64% were at goal for low-density lipoprotein cholesterol (LDL-C), 63% were at goal for non-high-density lipoprotein cholesterol (HDL-C), but only 52% were at goal for apoB. In all, 40.8%, 29.2%, and 39.4% remain 30% or more from goal for LDL-C, non-HDL, and apoB, respectively.
- Non-Hispanic blacks and those with cardiovascular disease or diabetes had the highest proportions that were not at goal for LDL-C, non-HDL-C, and apoB.
- Overall, 7.8% had apoB and 6.3% of subjects had non-HDL-C levels at or above the median despite LDL-C levels below median levels.
- Despite statin treatment, many persons continue to have residual dyslipidemia with LDL-C, non-HDL-C, and/or apoB levels not being at recommended levels.

BackgroundDespite being on treatment, many persons with dyslipidemia still have suboptimal lipid levels and still experience cardiovascular disease (CVD) events.ObjectiveWe examined the extent of residual dyslipidemia in terms of low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), and apolipoprotein B (apoB), in the US population, despite treatment with statin therapy.MethodsWe evaluated the attainment of LDL-C, non-HDL-C, and apoB targets in statin-treated subjects in the National Health and Nutrition Examination Survey 2009-2010. We report on percentage of individuals who attained goal and the mean distance from goal. LDL-C goals were set at <70 mg/dL for those with coronary heart disease, <100 mg/dL for those with other CVDs, diabetes, chronic kidney disease or >20% 10-year CVD risk, <130 mg/dL for those with 10% to 20% 10-year CVD risk or 2+ risk factors, and <160 mg/dL in those with <10% 10-year CVD risk or no more than 1 risk factor. Goals for non-HDL-C were 30 mg/dL higher than corresponding LDL-C goals, and goals of apoB were set to correspond with the same percentile of each LDL-C goal.ResultsOf the 5995 US adults aged ≥18 years surveyed, 463 (7.7%) were identified as being on a statin-based therapy. Overall, 64% of statin users were at goal for LDL-C, 63% were at goal for non-HDL-C, but only 52% were at goal for apoB. Of those who did not reach goal, 41%, 29%, and 39% were 30% or more from goal for LDL-C, non-HDL-C, and apoB, respectively. Non-Hispanic blacks and those with CVD or diabetes had the highest proportions that were not at goal for LDL-C, non-HDL-C, and apoB. Among those at goal for non-HDL-C, 50% of those with CHD and 33% of other high risk adults were not at ApoB goals.ConclusionsDespite statin treatment, many persons continue to have residual dyslipidemia with LDL-C, non-HDL-C, and/or apoB levels not being at recommended levels.