A troubling finding was that the greatest incidence of dangerously high LDL cholesterol is in the high-risk group. The prevalence of high LDL did decrease in that group, but only from 69.4 percent in the first survey to 58.9 percent in the last survey, the study authors reported.
As for the cause of the overall reduction, "we don't know why, we can only speculate," Kuklina said. It could be changes in lifestyle, such as better diet, or it could be more widespread use of cholesterol-lowering medications such as statins, she said.
"But we still have many people we could put on statins," Kuklina noted.
It's important to remember that LDL cholesterol is just "one of many risk factors for cardiovascular disease," said Dr. Thomas A. Gaziano, an assistant professor of medicine at Harvard Medical School and an associate physician at Brigham and Women's Hospital, and co-author of an accompanying editorial.
Doctors must consider all the risk factors when dealing with cardiovascular disease, Gaziano said. "We recommend simplifying how the risk is calculated," he said. "Once the risk is determined, therapy should be based on overall risk, not just on cholesterol."
There are different recommendations about the age at which cholesterol screening should begin, Kuklina noted. The CDC, the National Heart, Lung and Blood Institute and the American Heart Association recommend that screening tests should start at age 20, she said.
"I don't think it unreasonable to get screened once in the 20s, and then with increasing frequency in the 30s," Gaziano said.
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