Over 40% of US Adults With High Cholesterol Don't Know It and Aren't Getting Treatment

Many adults who have dangerously high cholesterol levels aren’t aware of it—and it’s putting them at risk for heart attack, stroke, and death, new research shows.

The new study, published earlier this month in JAMA Cardiology, determined that, while the prevalence of severely elevated low-density lipoprotein cholesterol (LDL-C) has declined in recent years, it hasn’t fallen enough: about 1 in 16 U.S. adults still have moderately high LDL-C levels of 160–189 mg/dL and 1 in 48 adults have very high LDL-C levels of 190 mg/dL or greater.

Among those with very high LDL cholesterol levels, about 27% aren’t aware or receiving treatment—and that number rises to about 43% for people with moderately high LDL levels.

Study authors note that this lack of awareness and treatment could be due to a variety of things, including trouble finding proper primary care, low screening rates, and disconnect regarding screening recommendations, among others.

Read on for more about why it’s so important to know your LDL-C levels, how to find out, and what to do if your cholesterol levels are higher than recommended.

High LDL Cholesterol on the Decline; Awareness and Treatment Less Than Ideal

For the new study, researchers looked at data from 23,667 participants between 1999 and 2020. Of those people, 1,851 (7.8%) had LDL-C levels of 160–189 mg/dL (moderately high), and 669 (2.8%) had levels of 190 mg/dL or greater (very high).

In comparing data from 1999–2000 and 2017–2020, researchers found that LDL-C levels actually decreased over the two decades. The percentage of people with moderately high LDL-C levels dropped from 12.4% to 6.1% (representing 7.5 million fewer people) and the percentage of people with very high LDL-C levels dropped from 3.8% to 2.1% (representing 1.8 million people).

The percentage of people who were unaware of and untreated for their high cholesterol dropped too. The percentage of participants with moderately high LDL-C levels dropped from 52.1% in 1999–2000 to 42.7% in 2017–2020; for those with very high LDL-C, declined from 40.8% to 26.8%.

Ultimately, despite a noticeable decline, researchers determined that about 1 in 16 U.S. adults still have moderately high cholesterol and 1 in 48 still have very high cholesterol—and many remain unaware and untreated.

Barriers to LDL Cholesterol Awareness and Treatment

According to the study authors, Black, Hispanic, and socioeconomically disadvantaged people disproportionately make up those who aren’t aware of or treated for their heightened LDL-C levels. Younger people, too, were also more affected.

Researchers also shared that the lack of awareness and treatment could be due to a few things, including having trouble accessing primary care and low rates of screening when patients are seen by a primary doctor.

For example, some people don’t receive primary care regularly, according to Nancy K. Sweitzer, MD, PhD, a cardiology professor at Washington University in St. Louis School of Medicine.

Lack of insurance can be a factor, too, added Jonathan Q. Purnell, MD, a professor at Oregon Health & Science University.

There are also inconsistencies on screening recommendations and “insufficient emphasis on LDL-C as a quality measure,” study authors noted.

“Because of this, there has been less focus on using a particular LDL-cholesterol level to guide treatment,” Nathan D. Wong, PhD, a professor and director of the heart disease prevention program at UC Irvine, told Health. “However, we still need to know such levels as a baseline, and to inform whether any treatment given is being effective or not, and this message is not getting out.”

There may also be a hesitancy to treat asymptomatic people. Current cholesterol management guidelines for statins, for example, which are a group of medications that can lower cholesterol, are based on current cardiovascular risk factors instead of past cholesterol levels.

Managing LDL-C and Other Heart Health Measures

Though important to know your LDL-C levels, it’s equally important to know your high-density lipoprotein cholesterol (HDL-C) and trigylceride levels—together known as a lipid panel. Keeping tabs on blood pressure and glucose levels can also gauge your cardiovascular disease risk.

Once you’ve determined your levels, you can then work with your doctor on a treatment plan, if needed, said Wong. Lifestyle changes like diet and exercise can keep your levels healthy. Depending on your risk and other risk-enhancing factors, your doctor may suggest medication, he added.

Statins sometimes get a bad reputation from people who complain about side effects like muscle aches and cognitive issues, said Sweitzer—but the amount of people who voice concerns may be exaggerated.

“Everybody on a statin thinks it must be the medication [causing the side effects],” said Sweitzer. “In a very small amount of people there can be issues, but it’s a tiny number of people.”

If you get your cholesterol checked and it’s high, Sweitzer said you can try lifestyle modifications. Give it six months and check your levels again; if things don’t improve, ask your doctor about medicine.

Statins aren’t the only option, though they’re an inexpensive first step for many people who need to reduce their cholesterol levels. According to Wong, non-statin therapies like Zetia (ezetimibe) and PCSK9 inhibitors such as Praluent (alirocumab) and Repatha (evolocumab), as well Nexletol (bempedoic acid) or Leqvio (inclisiran), are also options for high-risk people.

Looking to the future, researchers are also pondering gene editing approaches that have the potential to permanently reduce LDL in a single injection—but according to Wong, that’s still a while away.