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Ga Eun Nam, Kyungdo Han, Yong Gyu Park, Youn Seon Choi, Seon Mee Kim, Sang-Yhun Ju, Byung-Joon Ko, Yang Hyun Kim, Eun Hye Kim, Kyung Hwan Cho, Do Hoon Kim, Trends in lipid profiles among South Korean adults: 2005, 2008 and 2010 Korea National Health and Nutrition Examination Survey, Journal of Public Health, Volume 37, Issue 2, June 2015, Pages 286–294, https://doi.org/10.1093/pubmed/fdu012
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Abstract
This study aimed to investigate recent trends in the prevalence and parameters of dyslipidemia and rates of lipid-lowering medication use in Korean adults. Trends in lipid profiles in subjects with hypertension, diabetes or obesity were also studied.
Data from the Korea National Health and Nutrition Examination Survey in 2005, 2008 and 2010 were used in this study. A total of 17 009 subjects participated in this study.
There was a declining trend in the prevalence of dyslipidemia and an increasing trend in the rates of use of lipid-lowering medication among Korean adults. In both men and women, the age-adjusted mean high-density lipoprotein cholesterol level linearly increased. There was a significantly decreasing trend in the age-adjusted mean triglycerides in women and age-adjusted mean lipid-related ratios in both sexes. The age-adjusted mean total cholesterol level showed a slightly increasing trend and the age-adjusted mean low-density lipoprotein cholesterol level was not changed in both sexes. These patterns persisted among subjects not taking lipid-lowering medication. The favorable trends were also observed in subjects with hypertension, diabetes and obesity.
Our study showed favorable trends in the prevalence of dyslipidemia and in several lipid profiles among Korean adults.
Introduction
Dyslipidemia is generally defined as an increased level of total cholesterol (TC), triglycerides (TG) and low-density lipoprotein cholesterol (LDL-C) and a decreased level of high-density lipoprotein cholesterol (HDL-C).1 Several recent studies have shown that non-HDL-C level and lipid-related ratios are more susceptible in reflecting the severity and morbidity of coronary heart disease (CHD) than individual lipid and lipoprotein levels. Therefore, they are more meaningful than each lipid level in diagnosis and early prevention of CHD.2–4 However, little is known about the trends in non-HDL-C and lipid ratio levels among South Korean population.
Dyslipidemia is one of the most important risk factors for CHD and stroke. Many prior studies have demonstrated that morbidity and mortality from these diseases can be reduced by lowering the blood cholesterol level.5–10 Although mortality from CHD has decreased in developed countries, it has been rapidly rising in developing countries such as South Korea, China and other Asian countries over recent decades.11,12 CHD is now one of the leading causes of death, and the age at onset of CHD or stroke has been reported to be decreasing in South Korea, resulting in a higher lifetime disease burden. Therefore, more effective strategies are needed for prevention of CHD and stroke.13–15 In South Korea, the prevalence of dyslipidemia in adults has continuously increased from 32.4% in 1998 to 44.1% in 2005.16 However, there have been no subsequent updates of the prevalence of dyslipidemia and trends in lipid profiles, including the aforementioned novel parameters of dyslipidemia.
Therefore, this study aimed to investigate recent trends in lipid profiles including lipid ratios and the prevalence of dyslipidemia in Korean adults based on nationally representative data from the 2005, 2008 and 2010 Korea National Health and Nutrition Examination Survey (KNHANES). We also examined trends in rates of use of lipid-lowering medication and trends in lipid profiles in subjects not treated with lipid-lowering medication. Additionally, trends in lipid profiles in Korean adults with hypertension, diabetes or obesity were studied.
Methods
Survey overview and study subjects
The present study was based on data obtained from the KNHANES in 2005, 2008 and 2010. The KNHANES has been conducted periodically by the Division of Chronic Disease Surveillance of the Korea Centers for Disease Control and Prevention (KCDC) since 1998. It is a nationwide survey designed to assess national health and nutrition levels accurately and consists of a health interview survey, a nutrition survey and a health examination survey. This survey selected participants from sampling household units defined on the basis of household registries using a stratified, multistage and probability sampling design with proportional allocation.
Of the 10 816 people who participated in the 2005 survey, complete data were obtained from 7597 subjects (70.2%). Likewise, 9744 (77.8%) of 12 528 subjects in 2008 and 8518 (80.4%) of 10 589 subjects in 2010 participated in the survey. We then excluded subjects younger than 19 years of age, subjects with any missing data on lipid profiles and subjects who did not fast for at least 8 h before blood sampling. Finally, data on 5216 subjects from the 2005 survey, 6166 subjects from the 2008 survey and 5627 subjects from the 2010 survey were used in the analyses. All of the study participants provided written informed consent, and the institutional review board of the KCDC approved the study protocol.
Anthropometric and laboratory measurements
Trained staff performed a physical examination following standard procedures. Body weight and height were measured to the nearest 0.1 kg and 0.1 cm, respectively, while the subjects were wearing light clothing but no shoes. Body mass index (BMI) was calculated as weight in kilograms divided by the square of the height in meters. Systolic blood pressure and diastolic blood pressure were measured using a standard mercury sphygmomanometer.
Blood samples were taken after the subjects fasted for 8 or more hours. The samples were immediately centrifuged and refrigerated and then transported in cold storage to the Central Testing Institute in Seoul, Korea and analyzed within 24 h. The serum levels of TC, HDL-C, TG and fasting plasma glucose were measured enzymatically using an Advia 1650/2400 (Siemens, New York, NY, USA) in the 2005 survey and a Hitachi Automatic Analyzer 7600 (Hitachi, Tokyo, Japan) in the 2008 and 2010 surveys. LDL-C level was calculated using Friedewald's equation for subjects with serum TG levels <400 mg/dl and was measured directly using commercially available kits (Cholestest® LDL, Sekisui Medical, Tokyo, Japan) when TG levels were ≥400 mg/dl. Non-HDL-C was calculated as serum TC level minus HDL-C level.
Definition of dyslipidemia, hypertension, diabetes and obesity
According to the criteria of the National Cholesterol Education Program Adult Treatment Panel III, dyslipidemia was diagnosed when participants met one or more of the following criteria: (i) TC level ≥240 mg/dl on the blood test after fasting, (ii) HDL-C level <40 mg/dl, (iii) LDL-C level ≥160 mg/dl, (iv) TG level ≥200 mg/dl and (v) the use of lipid-lowering medication or diagnosis of dyslipidemia by a physician.17
Hypertension was defined by blood pressure ≥140/90 mmHg or treatment with antihypertensive medication. Diabetes was defined by fasting plasma glucose level ≥126 mg/dl, current use of insulin or oral hypoglycemic agents, or diagnosis by a physician. We defined obesity as a BMI ≥25 kg/m2.18,19
Statistical analyses
Statistical analyses were conducted using the SAS survey procedure (version 9.2; SAS Institute, Cary, NC, USA) to reflect the complex sampling design and sampling weights of KNHANES and to provide a nationally representative estimate of prevalence. Mean levels of TC, HDL-C, LDL-C, non-HDL-C level and lipid ratios, and the proportions of dyslipidemia and treatment with lipid-lowering medication are presented as least square means ± 95% confidence intervals or as proportions (standard errors). The geometric mean calculated by back transforming the logarithmic means of TG values is presented due to the skewed distribution of TG. Direct age adjustment of the data was conducted using the Korean population 19 years or older in 2010 as the standard population to compare the means of lipid profiles, prevalence of dyslipidemia and rate of use of lipid-lowering medication in Korean adults in each KNHANES. We also assessed trends in lipid profiles in subjects in subgroups of several conventional cardiovascular disease (CVD) risk factors, such as hypertension, diabetes and obesity. The P for trend for mean level of each lipid profile was estimated using a general linear model. Two-sided P-values of <0.05 were considered statistically significant.
Results
Trends in lipid profiles
Table 1 presents the trends in age-adjusted means of lipid profiles for Korean adults according to sex and age. The age-adjusted mean TC level for both men and women increased linearly from 2005 to 2008 and to 2010 (P for trend = 0.026 for men and 0.006 for women). Statistically significant increasing trends in age-adjusted mean TC levels were observed in men aged 40–65 years (P for trend = 0.009) and in women aged 19–40 years (P for trend = 0.006). The age-adjusted mean HDL-C level increased linearly in both men and women between 2005 and 2010 (P for trend <0.001). Increasing linear trends in age-adjusted mean HDL-C levels were observed in young- and middle-age groups in men and all age groups in women. The age-adjusted geometric mean TG level for men did not change significantly in any age group. However, in women, declining trends in the age-adjusted mean TG level were observed (P for trend <0.001). Young- and middle-aged women had significantly decreasing geometric means of TG level during this period (P for trend = 0.024 and <0.001, respectively). As for lipid ratios, the age-adjusted mean ratios of TC/HDL-C and LDL-C/HDL-C showed decreasing trends in all age groups for both sexes. The geometric mean TG/HDL-C ratios also showed decreasing trends in both men and women, and the trends persisted in the younger- and middle-age groups for both sexes. From 2005 to 2010, the age-adjusted mean levels of LDL-C and non-HDL-C showed no significant changes in all age groups for both sexes.
. | Men . | P for trend . | Women . | P for trend . | ||||
---|---|---|---|---|---|---|---|---|
2005 . | 2008 . | 2010 . | 2005 . | 2008 . | 2010 . | |||
n | 2170 | 2542 | 2390 | 3046 | 3624 | 3237 | ||
TC (mg/dl) | ||||||||
Overall | 184 (182.3–185.7) | 185.3 (183.6–187) | 186.9 (185.1–188.6) | 0.026 | 185.5 (184.1–186.9) | 188.4 (187.1–189.8) | 188.2 (186.6–189.9) | 0.006 |
19–40 years | 179.7 (176.9–182.4) | 180.4 (177.8–183.1) | 182.2 (179.5–184.9) | 0.222 | 169.8 (167.7–172) | 174.3 (172.6–176) | 173.7 (171.6–175.8) | 0.006 |
40–65 years | 187.6 (185.4–189.8) | 190.1 (188–192.2) | 191.9 (189.5–194.3) | 0.009 | 192.7 (190.6–194.8) | 193.9 (191.7–196) | 194.5 (192.1–197) | 0.261 |
≥65 years | 181.7 (177.7–185.6) | 180.7 (176.6–184.7) | 179.9 (176.5–183.3) | 0.501 | 198.5 (195.3–201.7) | 201.8 (198.5–205.2) | 198.6 (195.1–202.1) | 0.827 |
HDL-C (mg/dl) | ||||||||
Overall | 42.5 (42–43) | 45.5 (45–46) | 45.8 (45.2–46.3) | <0.001 | 47 (46.5–47.5) | 50.7 (50.2–51.2) | 50.7 (50.3–51.2) | <0.001 |
19–40 years | 43 (42.2–43.8) | 46.3 (45.6–47) | 46.4 (45.6–47.2) | <0.001 | 49 (48.1–49.8) | 53.6 (52.8–54.4) | 53.1 (52.3–53.9) | <0.001 |
40–65 years | 42.2 (41.5–42.9) | 45.3 (44.6–46) | 45.7 (44.9–46.6) | <0.001 | 46.9 (46.2–47.5) | 50.2 (49.5–50.8) | 50.7 (50–51.3) | <0.001 |
≥65 years | 43.2 (41.7–44.6) | 44.2 (43.2–45.1) | 44.5 (43.4–45.6) | 0.143 | 44.4 (43.5–45.4) | 46.4 (45.6–47.3) | 46.5 (45.4–47.5) | 0.003 |
LDL-C (mg/dl) | ||||||||
Overall | 113.7 (112.1–115.3) | 112 (110.5–113.5) | 113 (111.3–114.7) | 0.436 | 116.1 (114.9–117.3) | 115.7 (114.5–116.9) | 115.6 (114.3–117) | 0.584 |
19–40 years | 111.1 (108.6–113.6) | 108.2 (105.9–110.4) | 110.1 (107.5–112.6) | 0.437 | 103.1 (101.4–104.8) | 103.4 (101.9–105) | 103.1 (101.4–104.8) | 0.959 |
40–65 years | 115.3 (113.2–117.5) | 115.1 (113.2–117.1) | 115.9 (113.6–118.2) | 0.737 | 121.9 (120–123.8) | 120.6 (118.6–122.5) | 121.5 (119.4–123.6) | 0.68 |
≥65 years | 113.5 (109.7–117.2) | 110.8 (107–114.6) | 108.6 (105.3–111.9) | 0.061 | 127.3 (124.5–130.1) | 127 (124–129.9) | 123.5 (120.3–126.6) | 0.092 |
TG (mg/dl) | ||||||||
Overall | 123.7 (120.1–127.4) | 122.3 (119.2–125.4) | 122.8 (119.0–126.7) | 0.728 | 100.1 (98.1–102.0) | 95.7 (93.9–97.5) | 95.1 (93.3–96.9) | <0.001 |
19–40 years | 112.7 (107.6–118) | 113.4 (109.2–117.8) | 111.4 (105.7–117.3) | 0.795 | 80.9 (78.5–83.3) | 76.5 (74.4–78.7) | 77.3 (74.8–79.9) | 0.024 |
40–65 years | 135.4 (130.9–140) | 130.6 (126.3–135.1) | 133.1 (128.2–138.3) | 0.452 | 107.6 (104.3–110.9) | 101.3 (98.2–104.5) | 98.6 (95.7–101.6) | <0.001 |
≥65 years | 112 (104.2–120.3) | 114.3 (107.9–121.1) | 117.3 (110.1–125) | 0.351 | 123.3 (118.1–128.7) | 127.2 (122.2–132.5) | 127.2 (120.8–133.8) | 0.331 |
Non-HDL-C (mg/dl) | ||||||||
Overall | 141.5 (139.9–143.2) | 139.8 (138.2–141.5) | 141.1 (139.3–143) | 0.631 | 138.5 (137.2–139.8) | 137.7 (136.4–139) | 137.5 (135.9–139) | 0.307 |
19–40 years | 136.6 (134.1–139.2) | 134.1 (131.5–136.7) | 135.8 (133–138.5) | 0.521 | 120.9 (119–122.8) | 120.7 (119.1–122.3) | 120.6 (118.5–122.6) | 0.826 |
40–65 years | 145.4 (143.3–147.5) | 144.8 (142.7–146.9) | 146.2 (143.7–148.7) | 0.686 | 145.9 (143.9–147.9) | 143.7 (141.6–145.8) | 143.9 (141.5–146.2) | 0.163 |
≥65 years | 138.5 (134.4–142.6) | 136.5 (132.8–140.2) | 135.4 (131.6–139.2) | 0.265 | 154.1 (151.1–157.2) | 155.4 (152–158.8) | 152.2 (148.6–155.7) | 0.483 |
TC/HDL-C | ||||||||
Overall | 4.5 (4.45–4.56) | 4.23 (4.18–4.28) | 4.26 (4.19–4.32) | <0.001 | 4.09 (4.05–4.13) | 3.87 (3.84–3.91) | 3.85 (3.82–3.89) | <0.001 |
19–40 years | 4.33 (4.25–4.41) | 4.04 (3.97–4.12) | 4.08 (3.99–4.17) | <0.001 | 3.58 (3.52–3.63) | 3.36 (3.31–3.41) | 3.38 (3.32–3.44) | <0.001 |
40–65 years | 4.62 (4.55–4.70) | 4.35 (4.28–4.42) | 4.37 (4.28–4.46) | <0.001 | 4.26 (4.2–4.32) | 4.01 (3.95–4.07) | 3.96 (3.9–4.02) | <0.001 |
≥65 years | 4.43 (4.28–4.59) | 4.25 (4.15–4.35) | 4.23 (4.08–4.37) | 0.047 | 4.63 (4.53–4.73) | 4.51 (4.42–4.61) | 4.45 (4.33–4.57) | 0.017 |
LDL-C/HDL-C | ||||||||
Overall | 2.79 (2.75–2.84) | 2.57 (2.53–2.61) | 2.59 (2.53–2.64) | <0.001 | 2.57 (2.54–2.60) | 2.39 (2.36–2.42) | 2.38 (2.35–2.41) | <0.001 |
19–40 years | 2.69 (2.62–2.75) | 2.43 (2.37–2.5) | 2.48 (2.41–2.55) | <0.001 | 2.19 (2.14–2.23) | 2.01 (1.97–2.05) | 2.02 (1.98–2.07) | <0.001 |
40–65 years | 2.85 (2.79–2.91) | 2.65 (2.59–2.7) | 2.65 (2.58–2.73) | <0.001 | 2.7 (2.65–2.75) | 2.5 (2.45–2.55) | 2.48 (2.43–2.53) | <0.001 |
≥65 years | 2.79 (2.66–2.92) | 2.61 (2.52–2.71) | 2.56 (2.44–2.68) | 0.007 | 2.98 (2.9–3.05) | 2.84 (2.77–2.92) | 2.76 (2.67–2.85) | <0.001 |
TG/HDL-C | ||||||||
Overall | 4.10 (3.99–4.21) | 3.87 (3.79–3.96) | 3.89 (3.78–4.00) | 0.004 | 3.27 (3.21–3.33) | 3.06 (3.01–3.11) | 3.03 (2.99–3.08) | <0.001 |
19–40 years | 3.79 (3.64–3.94) | 3.62 (3.51–3.73) | 3.58 (3.43–3.74) | 0.047 | 2.75 (2.69–2.82) | 2.55 (2.49–2.61) | 2.57 (2.5–2.64) | <0.001 |
40–65 years | 4.4 (4.26–4.54) | 4.08 (3.95–4.2) | 4.12 (3.98–4.27) | 0.004 | 3.45 (3.36–3.55) | 3.18 (3.1–3.26) | 3.09 (3.02–3.17) | <0.001 |
≥65 years | 3.79 (3.56–4.04) | 3.77 (3.59–3.94) | 3.85 (3.65–4.07) | 0.723 | 3.93 (3.78–4.09) | 3.93 (3.79–4.07) | 3.93 (3.74–4.13) | 0.992 |
. | Men . | P for trend . | Women . | P for trend . | ||||
---|---|---|---|---|---|---|---|---|
2005 . | 2008 . | 2010 . | 2005 . | 2008 . | 2010 . | |||
n | 2170 | 2542 | 2390 | 3046 | 3624 | 3237 | ||
TC (mg/dl) | ||||||||
Overall | 184 (182.3–185.7) | 185.3 (183.6–187) | 186.9 (185.1–188.6) | 0.026 | 185.5 (184.1–186.9) | 188.4 (187.1–189.8) | 188.2 (186.6–189.9) | 0.006 |
19–40 years | 179.7 (176.9–182.4) | 180.4 (177.8–183.1) | 182.2 (179.5–184.9) | 0.222 | 169.8 (167.7–172) | 174.3 (172.6–176) | 173.7 (171.6–175.8) | 0.006 |
40–65 years | 187.6 (185.4–189.8) | 190.1 (188–192.2) | 191.9 (189.5–194.3) | 0.009 | 192.7 (190.6–194.8) | 193.9 (191.7–196) | 194.5 (192.1–197) | 0.261 |
≥65 years | 181.7 (177.7–185.6) | 180.7 (176.6–184.7) | 179.9 (176.5–183.3) | 0.501 | 198.5 (195.3–201.7) | 201.8 (198.5–205.2) | 198.6 (195.1–202.1) | 0.827 |
HDL-C (mg/dl) | ||||||||
Overall | 42.5 (42–43) | 45.5 (45–46) | 45.8 (45.2–46.3) | <0.001 | 47 (46.5–47.5) | 50.7 (50.2–51.2) | 50.7 (50.3–51.2) | <0.001 |
19–40 years | 43 (42.2–43.8) | 46.3 (45.6–47) | 46.4 (45.6–47.2) | <0.001 | 49 (48.1–49.8) | 53.6 (52.8–54.4) | 53.1 (52.3–53.9) | <0.001 |
40–65 years | 42.2 (41.5–42.9) | 45.3 (44.6–46) | 45.7 (44.9–46.6) | <0.001 | 46.9 (46.2–47.5) | 50.2 (49.5–50.8) | 50.7 (50–51.3) | <0.001 |
≥65 years | 43.2 (41.7–44.6) | 44.2 (43.2–45.1) | 44.5 (43.4–45.6) | 0.143 | 44.4 (43.5–45.4) | 46.4 (45.6–47.3) | 46.5 (45.4–47.5) | 0.003 |
LDL-C (mg/dl) | ||||||||
Overall | 113.7 (112.1–115.3) | 112 (110.5–113.5) | 113 (111.3–114.7) | 0.436 | 116.1 (114.9–117.3) | 115.7 (114.5–116.9) | 115.6 (114.3–117) | 0.584 |
19–40 years | 111.1 (108.6–113.6) | 108.2 (105.9–110.4) | 110.1 (107.5–112.6) | 0.437 | 103.1 (101.4–104.8) | 103.4 (101.9–105) | 103.1 (101.4–104.8) | 0.959 |
40–65 years | 115.3 (113.2–117.5) | 115.1 (113.2–117.1) | 115.9 (113.6–118.2) | 0.737 | 121.9 (120–123.8) | 120.6 (118.6–122.5) | 121.5 (119.4–123.6) | 0.68 |
≥65 years | 113.5 (109.7–117.2) | 110.8 (107–114.6) | 108.6 (105.3–111.9) | 0.061 | 127.3 (124.5–130.1) | 127 (124–129.9) | 123.5 (120.3–126.6) | 0.092 |
TG (mg/dl) | ||||||||
Overall | 123.7 (120.1–127.4) | 122.3 (119.2–125.4) | 122.8 (119.0–126.7) | 0.728 | 100.1 (98.1–102.0) | 95.7 (93.9–97.5) | 95.1 (93.3–96.9) | <0.001 |
19–40 years | 112.7 (107.6–118) | 113.4 (109.2–117.8) | 111.4 (105.7–117.3) | 0.795 | 80.9 (78.5–83.3) | 76.5 (74.4–78.7) | 77.3 (74.8–79.9) | 0.024 |
40–65 years | 135.4 (130.9–140) | 130.6 (126.3–135.1) | 133.1 (128.2–138.3) | 0.452 | 107.6 (104.3–110.9) | 101.3 (98.2–104.5) | 98.6 (95.7–101.6) | <0.001 |
≥65 years | 112 (104.2–120.3) | 114.3 (107.9–121.1) | 117.3 (110.1–125) | 0.351 | 123.3 (118.1–128.7) | 127.2 (122.2–132.5) | 127.2 (120.8–133.8) | 0.331 |
Non-HDL-C (mg/dl) | ||||||||
Overall | 141.5 (139.9–143.2) | 139.8 (138.2–141.5) | 141.1 (139.3–143) | 0.631 | 138.5 (137.2–139.8) | 137.7 (136.4–139) | 137.5 (135.9–139) | 0.307 |
19–40 years | 136.6 (134.1–139.2) | 134.1 (131.5–136.7) | 135.8 (133–138.5) | 0.521 | 120.9 (119–122.8) | 120.7 (119.1–122.3) | 120.6 (118.5–122.6) | 0.826 |
40–65 years | 145.4 (143.3–147.5) | 144.8 (142.7–146.9) | 146.2 (143.7–148.7) | 0.686 | 145.9 (143.9–147.9) | 143.7 (141.6–145.8) | 143.9 (141.5–146.2) | 0.163 |
≥65 years | 138.5 (134.4–142.6) | 136.5 (132.8–140.2) | 135.4 (131.6–139.2) | 0.265 | 154.1 (151.1–157.2) | 155.4 (152–158.8) | 152.2 (148.6–155.7) | 0.483 |
TC/HDL-C | ||||||||
Overall | 4.5 (4.45–4.56) | 4.23 (4.18–4.28) | 4.26 (4.19–4.32) | <0.001 | 4.09 (4.05–4.13) | 3.87 (3.84–3.91) | 3.85 (3.82–3.89) | <0.001 |
19–40 years | 4.33 (4.25–4.41) | 4.04 (3.97–4.12) | 4.08 (3.99–4.17) | <0.001 | 3.58 (3.52–3.63) | 3.36 (3.31–3.41) | 3.38 (3.32–3.44) | <0.001 |
40–65 years | 4.62 (4.55–4.70) | 4.35 (4.28–4.42) | 4.37 (4.28–4.46) | <0.001 | 4.26 (4.2–4.32) | 4.01 (3.95–4.07) | 3.96 (3.9–4.02) | <0.001 |
≥65 years | 4.43 (4.28–4.59) | 4.25 (4.15–4.35) | 4.23 (4.08–4.37) | 0.047 | 4.63 (4.53–4.73) | 4.51 (4.42–4.61) | 4.45 (4.33–4.57) | 0.017 |
LDL-C/HDL-C | ||||||||
Overall | 2.79 (2.75–2.84) | 2.57 (2.53–2.61) | 2.59 (2.53–2.64) | <0.001 | 2.57 (2.54–2.60) | 2.39 (2.36–2.42) | 2.38 (2.35–2.41) | <0.001 |
19–40 years | 2.69 (2.62–2.75) | 2.43 (2.37–2.5) | 2.48 (2.41–2.55) | <0.001 | 2.19 (2.14–2.23) | 2.01 (1.97–2.05) | 2.02 (1.98–2.07) | <0.001 |
40–65 years | 2.85 (2.79–2.91) | 2.65 (2.59–2.7) | 2.65 (2.58–2.73) | <0.001 | 2.7 (2.65–2.75) | 2.5 (2.45–2.55) | 2.48 (2.43–2.53) | <0.001 |
≥65 years | 2.79 (2.66–2.92) | 2.61 (2.52–2.71) | 2.56 (2.44–2.68) | 0.007 | 2.98 (2.9–3.05) | 2.84 (2.77–2.92) | 2.76 (2.67–2.85) | <0.001 |
TG/HDL-C | ||||||||
Overall | 4.10 (3.99–4.21) | 3.87 (3.79–3.96) | 3.89 (3.78–4.00) | 0.004 | 3.27 (3.21–3.33) | 3.06 (3.01–3.11) | 3.03 (2.99–3.08) | <0.001 |
19–40 years | 3.79 (3.64–3.94) | 3.62 (3.51–3.73) | 3.58 (3.43–3.74) | 0.047 | 2.75 (2.69–2.82) | 2.55 (2.49–2.61) | 2.57 (2.5–2.64) | <0.001 |
40–65 years | 4.4 (4.26–4.54) | 4.08 (3.95–4.2) | 4.12 (3.98–4.27) | 0.004 | 3.45 (3.36–3.55) | 3.18 (3.1–3.26) | 3.09 (3.02–3.17) | <0.001 |
≥65 years | 3.79 (3.56–4.04) | 3.77 (3.59–3.94) | 3.85 (3.65–4.07) | 0.723 | 3.93 (3.78–4.09) | 3.93 (3.79–4.07) | 3.93 (3.74–4.13) | 0.992 |
KNHANES, Korea National Health and Nutrition Examination Survey; TC, total cholesterol; TG, triglycerides; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol. Data are presented as mean ± 95% confidence intervals. The P for trend was estimated using a general linear model.
. | Men . | P for trend . | Women . | P for trend . | ||||
---|---|---|---|---|---|---|---|---|
2005 . | 2008 . | 2010 . | 2005 . | 2008 . | 2010 . | |||
n | 2170 | 2542 | 2390 | 3046 | 3624 | 3237 | ||
TC (mg/dl) | ||||||||
Overall | 184 (182.3–185.7) | 185.3 (183.6–187) | 186.9 (185.1–188.6) | 0.026 | 185.5 (184.1–186.9) | 188.4 (187.1–189.8) | 188.2 (186.6–189.9) | 0.006 |
19–40 years | 179.7 (176.9–182.4) | 180.4 (177.8–183.1) | 182.2 (179.5–184.9) | 0.222 | 169.8 (167.7–172) | 174.3 (172.6–176) | 173.7 (171.6–175.8) | 0.006 |
40–65 years | 187.6 (185.4–189.8) | 190.1 (188–192.2) | 191.9 (189.5–194.3) | 0.009 | 192.7 (190.6–194.8) | 193.9 (191.7–196) | 194.5 (192.1–197) | 0.261 |
≥65 years | 181.7 (177.7–185.6) | 180.7 (176.6–184.7) | 179.9 (176.5–183.3) | 0.501 | 198.5 (195.3–201.7) | 201.8 (198.5–205.2) | 198.6 (195.1–202.1) | 0.827 |
HDL-C (mg/dl) | ||||||||
Overall | 42.5 (42–43) | 45.5 (45–46) | 45.8 (45.2–46.3) | <0.001 | 47 (46.5–47.5) | 50.7 (50.2–51.2) | 50.7 (50.3–51.2) | <0.001 |
19–40 years | 43 (42.2–43.8) | 46.3 (45.6–47) | 46.4 (45.6–47.2) | <0.001 | 49 (48.1–49.8) | 53.6 (52.8–54.4) | 53.1 (52.3–53.9) | <0.001 |
40–65 years | 42.2 (41.5–42.9) | 45.3 (44.6–46) | 45.7 (44.9–46.6) | <0.001 | 46.9 (46.2–47.5) | 50.2 (49.5–50.8) | 50.7 (50–51.3) | <0.001 |
≥65 years | 43.2 (41.7–44.6) | 44.2 (43.2–45.1) | 44.5 (43.4–45.6) | 0.143 | 44.4 (43.5–45.4) | 46.4 (45.6–47.3) | 46.5 (45.4–47.5) | 0.003 |
LDL-C (mg/dl) | ||||||||
Overall | 113.7 (112.1–115.3) | 112 (110.5–113.5) | 113 (111.3–114.7) | 0.436 | 116.1 (114.9–117.3) | 115.7 (114.5–116.9) | 115.6 (114.3–117) | 0.584 |
19–40 years | 111.1 (108.6–113.6) | 108.2 (105.9–110.4) | 110.1 (107.5–112.6) | 0.437 | 103.1 (101.4–104.8) | 103.4 (101.9–105) | 103.1 (101.4–104.8) | 0.959 |
40–65 years | 115.3 (113.2–117.5) | 115.1 (113.2–117.1) | 115.9 (113.6–118.2) | 0.737 | 121.9 (120–123.8) | 120.6 (118.6–122.5) | 121.5 (119.4–123.6) | 0.68 |
≥65 years | 113.5 (109.7–117.2) | 110.8 (107–114.6) | 108.6 (105.3–111.9) | 0.061 | 127.3 (124.5–130.1) | 127 (124–129.9) | 123.5 (120.3–126.6) | 0.092 |
TG (mg/dl) | ||||||||
Overall | 123.7 (120.1–127.4) | 122.3 (119.2–125.4) | 122.8 (119.0–126.7) | 0.728 | 100.1 (98.1–102.0) | 95.7 (93.9–97.5) | 95.1 (93.3–96.9) | <0.001 |
19–40 years | 112.7 (107.6–118) | 113.4 (109.2–117.8) | 111.4 (105.7–117.3) | 0.795 | 80.9 (78.5–83.3) | 76.5 (74.4–78.7) | 77.3 (74.8–79.9) | 0.024 |
40–65 years | 135.4 (130.9–140) | 130.6 (126.3–135.1) | 133.1 (128.2–138.3) | 0.452 | 107.6 (104.3–110.9) | 101.3 (98.2–104.5) | 98.6 (95.7–101.6) | <0.001 |
≥65 years | 112 (104.2–120.3) | 114.3 (107.9–121.1) | 117.3 (110.1–125) | 0.351 | 123.3 (118.1–128.7) | 127.2 (122.2–132.5) | 127.2 (120.8–133.8) | 0.331 |
Non-HDL-C (mg/dl) | ||||||||
Overall | 141.5 (139.9–143.2) | 139.8 (138.2–141.5) | 141.1 (139.3–143) | 0.631 | 138.5 (137.2–139.8) | 137.7 (136.4–139) | 137.5 (135.9–139) | 0.307 |
19–40 years | 136.6 (134.1–139.2) | 134.1 (131.5–136.7) | 135.8 (133–138.5) | 0.521 | 120.9 (119–122.8) | 120.7 (119.1–122.3) | 120.6 (118.5–122.6) | 0.826 |
40–65 years | 145.4 (143.3–147.5) | 144.8 (142.7–146.9) | 146.2 (143.7–148.7) | 0.686 | 145.9 (143.9–147.9) | 143.7 (141.6–145.8) | 143.9 (141.5–146.2) | 0.163 |
≥65 years | 138.5 (134.4–142.6) | 136.5 (132.8–140.2) | 135.4 (131.6–139.2) | 0.265 | 154.1 (151.1–157.2) | 155.4 (152–158.8) | 152.2 (148.6–155.7) | 0.483 |
TC/HDL-C | ||||||||
Overall | 4.5 (4.45–4.56) | 4.23 (4.18–4.28) | 4.26 (4.19–4.32) | <0.001 | 4.09 (4.05–4.13) | 3.87 (3.84–3.91) | 3.85 (3.82–3.89) | <0.001 |
19–40 years | 4.33 (4.25–4.41) | 4.04 (3.97–4.12) | 4.08 (3.99–4.17) | <0.001 | 3.58 (3.52–3.63) | 3.36 (3.31–3.41) | 3.38 (3.32–3.44) | <0.001 |
40–65 years | 4.62 (4.55–4.70) | 4.35 (4.28–4.42) | 4.37 (4.28–4.46) | <0.001 | 4.26 (4.2–4.32) | 4.01 (3.95–4.07) | 3.96 (3.9–4.02) | <0.001 |
≥65 years | 4.43 (4.28–4.59) | 4.25 (4.15–4.35) | 4.23 (4.08–4.37) | 0.047 | 4.63 (4.53–4.73) | 4.51 (4.42–4.61) | 4.45 (4.33–4.57) | 0.017 |
LDL-C/HDL-C | ||||||||
Overall | 2.79 (2.75–2.84) | 2.57 (2.53–2.61) | 2.59 (2.53–2.64) | <0.001 | 2.57 (2.54–2.60) | 2.39 (2.36–2.42) | 2.38 (2.35–2.41) | <0.001 |
19–40 years | 2.69 (2.62–2.75) | 2.43 (2.37–2.5) | 2.48 (2.41–2.55) | <0.001 | 2.19 (2.14–2.23) | 2.01 (1.97–2.05) | 2.02 (1.98–2.07) | <0.001 |
40–65 years | 2.85 (2.79–2.91) | 2.65 (2.59–2.7) | 2.65 (2.58–2.73) | <0.001 | 2.7 (2.65–2.75) | 2.5 (2.45–2.55) | 2.48 (2.43–2.53) | <0.001 |
≥65 years | 2.79 (2.66–2.92) | 2.61 (2.52–2.71) | 2.56 (2.44–2.68) | 0.007 | 2.98 (2.9–3.05) | 2.84 (2.77–2.92) | 2.76 (2.67–2.85) | <0.001 |
TG/HDL-C | ||||||||
Overall | 4.10 (3.99–4.21) | 3.87 (3.79–3.96) | 3.89 (3.78–4.00) | 0.004 | 3.27 (3.21–3.33) | 3.06 (3.01–3.11) | 3.03 (2.99–3.08) | <0.001 |
19–40 years | 3.79 (3.64–3.94) | 3.62 (3.51–3.73) | 3.58 (3.43–3.74) | 0.047 | 2.75 (2.69–2.82) | 2.55 (2.49–2.61) | 2.57 (2.5–2.64) | <0.001 |
40–65 years | 4.4 (4.26–4.54) | 4.08 (3.95–4.2) | 4.12 (3.98–4.27) | 0.004 | 3.45 (3.36–3.55) | 3.18 (3.1–3.26) | 3.09 (3.02–3.17) | <0.001 |
≥65 years | 3.79 (3.56–4.04) | 3.77 (3.59–3.94) | 3.85 (3.65–4.07) | 0.723 | 3.93 (3.78–4.09) | 3.93 (3.79–4.07) | 3.93 (3.74–4.13) | 0.992 |
. | Men . | P for trend . | Women . | P for trend . | ||||
---|---|---|---|---|---|---|---|---|
2005 . | 2008 . | 2010 . | 2005 . | 2008 . | 2010 . | |||
n | 2170 | 2542 | 2390 | 3046 | 3624 | 3237 | ||
TC (mg/dl) | ||||||||
Overall | 184 (182.3–185.7) | 185.3 (183.6–187) | 186.9 (185.1–188.6) | 0.026 | 185.5 (184.1–186.9) | 188.4 (187.1–189.8) | 188.2 (186.6–189.9) | 0.006 |
19–40 years | 179.7 (176.9–182.4) | 180.4 (177.8–183.1) | 182.2 (179.5–184.9) | 0.222 | 169.8 (167.7–172) | 174.3 (172.6–176) | 173.7 (171.6–175.8) | 0.006 |
40–65 years | 187.6 (185.4–189.8) | 190.1 (188–192.2) | 191.9 (189.5–194.3) | 0.009 | 192.7 (190.6–194.8) | 193.9 (191.7–196) | 194.5 (192.1–197) | 0.261 |
≥65 years | 181.7 (177.7–185.6) | 180.7 (176.6–184.7) | 179.9 (176.5–183.3) | 0.501 | 198.5 (195.3–201.7) | 201.8 (198.5–205.2) | 198.6 (195.1–202.1) | 0.827 |
HDL-C (mg/dl) | ||||||||
Overall | 42.5 (42–43) | 45.5 (45–46) | 45.8 (45.2–46.3) | <0.001 | 47 (46.5–47.5) | 50.7 (50.2–51.2) | 50.7 (50.3–51.2) | <0.001 |
19–40 years | 43 (42.2–43.8) | 46.3 (45.6–47) | 46.4 (45.6–47.2) | <0.001 | 49 (48.1–49.8) | 53.6 (52.8–54.4) | 53.1 (52.3–53.9) | <0.001 |
40–65 years | 42.2 (41.5–42.9) | 45.3 (44.6–46) | 45.7 (44.9–46.6) | <0.001 | 46.9 (46.2–47.5) | 50.2 (49.5–50.8) | 50.7 (50–51.3) | <0.001 |
≥65 years | 43.2 (41.7–44.6) | 44.2 (43.2–45.1) | 44.5 (43.4–45.6) | 0.143 | 44.4 (43.5–45.4) | 46.4 (45.6–47.3) | 46.5 (45.4–47.5) | 0.003 |
LDL-C (mg/dl) | ||||||||
Overall | 113.7 (112.1–115.3) | 112 (110.5–113.5) | 113 (111.3–114.7) | 0.436 | 116.1 (114.9–117.3) | 115.7 (114.5–116.9) | 115.6 (114.3–117) | 0.584 |
19–40 years | 111.1 (108.6–113.6) | 108.2 (105.9–110.4) | 110.1 (107.5–112.6) | 0.437 | 103.1 (101.4–104.8) | 103.4 (101.9–105) | 103.1 (101.4–104.8) | 0.959 |
40–65 years | 115.3 (113.2–117.5) | 115.1 (113.2–117.1) | 115.9 (113.6–118.2) | 0.737 | 121.9 (120–123.8) | 120.6 (118.6–122.5) | 121.5 (119.4–123.6) | 0.68 |
≥65 years | 113.5 (109.7–117.2) | 110.8 (107–114.6) | 108.6 (105.3–111.9) | 0.061 | 127.3 (124.5–130.1) | 127 (124–129.9) | 123.5 (120.3–126.6) | 0.092 |
TG (mg/dl) | ||||||||
Overall | 123.7 (120.1–127.4) | 122.3 (119.2–125.4) | 122.8 (119.0–126.7) | 0.728 | 100.1 (98.1–102.0) | 95.7 (93.9–97.5) | 95.1 (93.3–96.9) | <0.001 |
19–40 years | 112.7 (107.6–118) | 113.4 (109.2–117.8) | 111.4 (105.7–117.3) | 0.795 | 80.9 (78.5–83.3) | 76.5 (74.4–78.7) | 77.3 (74.8–79.9) | 0.024 |
40–65 years | 135.4 (130.9–140) | 130.6 (126.3–135.1) | 133.1 (128.2–138.3) | 0.452 | 107.6 (104.3–110.9) | 101.3 (98.2–104.5) | 98.6 (95.7–101.6) | <0.001 |
≥65 years | 112 (104.2–120.3) | 114.3 (107.9–121.1) | 117.3 (110.1–125) | 0.351 | 123.3 (118.1–128.7) | 127.2 (122.2–132.5) | 127.2 (120.8–133.8) | 0.331 |
Non-HDL-C (mg/dl) | ||||||||
Overall | 141.5 (139.9–143.2) | 139.8 (138.2–141.5) | 141.1 (139.3–143) | 0.631 | 138.5 (137.2–139.8) | 137.7 (136.4–139) | 137.5 (135.9–139) | 0.307 |
19–40 years | 136.6 (134.1–139.2) | 134.1 (131.5–136.7) | 135.8 (133–138.5) | 0.521 | 120.9 (119–122.8) | 120.7 (119.1–122.3) | 120.6 (118.5–122.6) | 0.826 |
40–65 years | 145.4 (143.3–147.5) | 144.8 (142.7–146.9) | 146.2 (143.7–148.7) | 0.686 | 145.9 (143.9–147.9) | 143.7 (141.6–145.8) | 143.9 (141.5–146.2) | 0.163 |
≥65 years | 138.5 (134.4–142.6) | 136.5 (132.8–140.2) | 135.4 (131.6–139.2) | 0.265 | 154.1 (151.1–157.2) | 155.4 (152–158.8) | 152.2 (148.6–155.7) | 0.483 |
TC/HDL-C | ||||||||
Overall | 4.5 (4.45–4.56) | 4.23 (4.18–4.28) | 4.26 (4.19–4.32) | <0.001 | 4.09 (4.05–4.13) | 3.87 (3.84–3.91) | 3.85 (3.82–3.89) | <0.001 |
19–40 years | 4.33 (4.25–4.41) | 4.04 (3.97–4.12) | 4.08 (3.99–4.17) | <0.001 | 3.58 (3.52–3.63) | 3.36 (3.31–3.41) | 3.38 (3.32–3.44) | <0.001 |
40–65 years | 4.62 (4.55–4.70) | 4.35 (4.28–4.42) | 4.37 (4.28–4.46) | <0.001 | 4.26 (4.2–4.32) | 4.01 (3.95–4.07) | 3.96 (3.9–4.02) | <0.001 |
≥65 years | 4.43 (4.28–4.59) | 4.25 (4.15–4.35) | 4.23 (4.08–4.37) | 0.047 | 4.63 (4.53–4.73) | 4.51 (4.42–4.61) | 4.45 (4.33–4.57) | 0.017 |
LDL-C/HDL-C | ||||||||
Overall | 2.79 (2.75–2.84) | 2.57 (2.53–2.61) | 2.59 (2.53–2.64) | <0.001 | 2.57 (2.54–2.60) | 2.39 (2.36–2.42) | 2.38 (2.35–2.41) | <0.001 |
19–40 years | 2.69 (2.62–2.75) | 2.43 (2.37–2.5) | 2.48 (2.41–2.55) | <0.001 | 2.19 (2.14–2.23) | 2.01 (1.97–2.05) | 2.02 (1.98–2.07) | <0.001 |
40–65 years | 2.85 (2.79–2.91) | 2.65 (2.59–2.7) | 2.65 (2.58–2.73) | <0.001 | 2.7 (2.65–2.75) | 2.5 (2.45–2.55) | 2.48 (2.43–2.53) | <0.001 |
≥65 years | 2.79 (2.66–2.92) | 2.61 (2.52–2.71) | 2.56 (2.44–2.68) | 0.007 | 2.98 (2.9–3.05) | 2.84 (2.77–2.92) | 2.76 (2.67–2.85) | <0.001 |
TG/HDL-C | ||||||||
Overall | 4.10 (3.99–4.21) | 3.87 (3.79–3.96) | 3.89 (3.78–4.00) | 0.004 | 3.27 (3.21–3.33) | 3.06 (3.01–3.11) | 3.03 (2.99–3.08) | <0.001 |
19–40 years | 3.79 (3.64–3.94) | 3.62 (3.51–3.73) | 3.58 (3.43–3.74) | 0.047 | 2.75 (2.69–2.82) | 2.55 (2.49–2.61) | 2.57 (2.5–2.64) | <0.001 |
40–65 years | 4.4 (4.26–4.54) | 4.08 (3.95–4.2) | 4.12 (3.98–4.27) | 0.004 | 3.45 (3.36–3.55) | 3.18 (3.1–3.26) | 3.09 (3.02–3.17) | <0.001 |
≥65 years | 3.79 (3.56–4.04) | 3.77 (3.59–3.94) | 3.85 (3.65–4.07) | 0.723 | 3.93 (3.78–4.09) | 3.93 (3.79–4.07) | 3.93 (3.74–4.13) | 0.992 |
KNHANES, Korea National Health and Nutrition Examination Survey; TC, total cholesterol; TG, triglycerides; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol. Data are presented as mean ± 95% confidence intervals. The P for trend was estimated using a general linear model.
Trends in the prevalence of dyslipidemia
The trends in the prevalence of dyslipidemia in Korean adults between 2005 and 2010 are presented in Fig. 1. The prevalence of dyslipidemia decreased from 44.7% in 2005 to 41.3% in 2010 (P for trend <0.001), and these trends persisted in both sex groups. The prevalence declined linearly from 53.4% in 2005 to 50% in 2010 in men (P for trend <0.001) and from 36.1% in 2005 to 32.5% in 2010 in women (P for trend = 0.002). Additional information on the prevalence of dyslipidemia by age group is shown in Supplementary data, Table S1; the prevalence of dyslipidemia appears to be in a declining trend, particularly in younger-aged men and younger- and middle-aged women.
Trends in the use of lipid-lowering medication
Figure 1 also shows trends in the use of lipid-lowering medication. The overall proportion of subjects treated with lipid-lowering medication increased linearly from 1.36% in 2005 to 2.92% in 2008 and to 5.34% in 2010 (P for trend <0.001). These trends continued in both men and women (P for trend <0.001).
Trends in lipid profiles in subjects not taking lipid-lowering medication
Table 2 shows trends in age- and sex-adjusted mean levels of lipid profiles among subjects not treated with lipid-lowering medication. The age- and sex-adjusted mean HDL-C level increased linearly across the survey years (P for trend <0.001). Age- and sex-adjusted geometric mean TG and TG/HDL-C levels and means of TC/HDL-C and LDL-C/HDL-C ratios showed significantly declining trends. However, there was an increasing trend for age- and sex-adjusted mean TC levels in these subjects.
. | 2005 . | 2008 . | 2010 . | P for trend . |
---|---|---|---|---|
n | 5148 | 5983 | 5330 | |
TC (mg/dl) | 185 (183.8–186.2) | 187.3 (186.1–188.6) | 188.5 (187.2–189.8) | <0.001 |
HDL-C (mg/dl) | 45.2 (44.8–45.5) | 48.5 (48.1–48.9) | 48.7 (48.3–49.1) | <0.001 |
LDL-C (mg/dl) | 115.3 (114.3–116.3) | 114.5 (113.4–115.5) | 115.5 (114.3–116.6) | 0.958 |
TG (mg/dl) | 108.9 (106.8–111) | 105.7 (103.9–107.5) | 105.3 (103.3–107.3) | 0.012 |
Non-HDL-C (mg/dl) | 139.9 (138.8–141) | 138.9 (137.7–140) | 139.8 (138.5–141.1) | 0.802 |
TC/HDL-C | 4.27 (4.23–4.3) | 4.03 (3.99–4.07) | 4.04 (4–4.08) | <0.001 |
LDL-C/HDL-C | 2.67 (2.64–2.69) | 2.47 (2.44–2.5) | 2.48 (2.45–2.52) | <0.001 |
TG/HDL-C | 3.6 (3.54–3.66) | 3.38 (3.34–3.43) | 3.37 (3.32–3.42) | <0.001 |
. | 2005 . | 2008 . | 2010 . | P for trend . |
---|---|---|---|---|
n | 5148 | 5983 | 5330 | |
TC (mg/dl) | 185 (183.8–186.2) | 187.3 (186.1–188.6) | 188.5 (187.2–189.8) | <0.001 |
HDL-C (mg/dl) | 45.2 (44.8–45.5) | 48.5 (48.1–48.9) | 48.7 (48.3–49.1) | <0.001 |
LDL-C (mg/dl) | 115.3 (114.3–116.3) | 114.5 (113.4–115.5) | 115.5 (114.3–116.6) | 0.958 |
TG (mg/dl) | 108.9 (106.8–111) | 105.7 (103.9–107.5) | 105.3 (103.3–107.3) | 0.012 |
Non-HDL-C (mg/dl) | 139.9 (138.8–141) | 138.9 (137.7–140) | 139.8 (138.5–141.1) | 0.802 |
TC/HDL-C | 4.27 (4.23–4.3) | 4.03 (3.99–4.07) | 4.04 (4–4.08) | <0.001 |
LDL-C/HDL-C | 2.67 (2.64–2.69) | 2.47 (2.44–2.5) | 2.48 (2.45–2.52) | <0.001 |
TG/HDL-C | 3.6 (3.54–3.66) | 3.38 (3.34–3.43) | 3.37 (3.32–3.42) | <0.001 |
KNHANES, Korea National Health and Nutrition Examination Survey; TC, total cholesterol; TG, triglycerides; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol. Data are presented as mean ± 95% confidence intervals. The P for trend was estimated using a general linear model.
. | 2005 . | 2008 . | 2010 . | P for trend . |
---|---|---|---|---|
n | 5148 | 5983 | 5330 | |
TC (mg/dl) | 185 (183.8–186.2) | 187.3 (186.1–188.6) | 188.5 (187.2–189.8) | <0.001 |
HDL-C (mg/dl) | 45.2 (44.8–45.5) | 48.5 (48.1–48.9) | 48.7 (48.3–49.1) | <0.001 |
LDL-C (mg/dl) | 115.3 (114.3–116.3) | 114.5 (113.4–115.5) | 115.5 (114.3–116.6) | 0.958 |
TG (mg/dl) | 108.9 (106.8–111) | 105.7 (103.9–107.5) | 105.3 (103.3–107.3) | 0.012 |
Non-HDL-C (mg/dl) | 139.9 (138.8–141) | 138.9 (137.7–140) | 139.8 (138.5–141.1) | 0.802 |
TC/HDL-C | 4.27 (4.23–4.3) | 4.03 (3.99–4.07) | 4.04 (4–4.08) | <0.001 |
LDL-C/HDL-C | 2.67 (2.64–2.69) | 2.47 (2.44–2.5) | 2.48 (2.45–2.52) | <0.001 |
TG/HDL-C | 3.6 (3.54–3.66) | 3.38 (3.34–3.43) | 3.37 (3.32–3.42) | <0.001 |
. | 2005 . | 2008 . | 2010 . | P for trend . |
---|---|---|---|---|
n | 5148 | 5983 | 5330 | |
TC (mg/dl) | 185 (183.8–186.2) | 187.3 (186.1–188.6) | 188.5 (187.2–189.8) | <0.001 |
HDL-C (mg/dl) | 45.2 (44.8–45.5) | 48.5 (48.1–48.9) | 48.7 (48.3–49.1) | <0.001 |
LDL-C (mg/dl) | 115.3 (114.3–116.3) | 114.5 (113.4–115.5) | 115.5 (114.3–116.6) | 0.958 |
TG (mg/dl) | 108.9 (106.8–111) | 105.7 (103.9–107.5) | 105.3 (103.3–107.3) | 0.012 |
Non-HDL-C (mg/dl) | 139.9 (138.8–141) | 138.9 (137.7–140) | 139.8 (138.5–141.1) | 0.802 |
TC/HDL-C | 4.27 (4.23–4.3) | 4.03 (3.99–4.07) | 4.04 (4–4.08) | <0.001 |
LDL-C/HDL-C | 2.67 (2.64–2.69) | 2.47 (2.44–2.5) | 2.48 (2.45–2.52) | <0.001 |
TG/HDL-C | 3.6 (3.54–3.66) | 3.38 (3.34–3.43) | 3.37 (3.32–3.42) | <0.001 |
KNHANES, Korea National Health and Nutrition Examination Survey; TC, total cholesterol; TG, triglycerides; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol. Data are presented as mean ± 95% confidence intervals. The P for trend was estimated using a general linear model.
Trends in lipid profiles according to use of lipid-lowering medication in subgroups with hypertension, diabetes and obesity
Table 3 shows trends in mean levels of lipid profiles according to use of lipid-lowering medication in subgroups with conventional CVD risk factors such as hypertension, diabetes and obesity. Among hypertensive subjects, the age- and sex-adjusted mean HDL-C level significantly increased linearly and the age- and sex-adjusted mean TC/HDL-C, LDL-C/HDL-C and geometric mean TG/HDL-C ratios decreased linearly across the survey years. Similar trends were observed in hypertensive subjects who did not use lipid-lowering medication.
. | n . | TC . | HDL-C . | LDL-C . | TG . | Non-HDL-C . | TC/HDL-C . | LDL-C/HDL-C . | TG/HDL-C . |
---|---|---|---|---|---|---|---|---|---|
Subjects with hypertension | |||||||||
2005 | 1277 | 193.2 (191.1–195.2) | 43.6 (42.9–44.2) | 119.6 (117.7–121.5) | 135.4 (131–140) | 149.6 (147.6–151.6) | 4.61 (4.54–4.68) | 2.86 (2.81–2.91) | 4.3 (4.17–4.44) |
2008 | 1601 | 195 (192.6–197.4) | 46.7 (46–47.4) | 118.9 (116.7–121.1) | 129.8 (125.5–134.2) | 148.3 (145.9–150.6) | 4.35 (4.28–4.42) | 2.66 (2.6–2.72) | 3.98 (3.87–4.1) |
2010 | 1822 | 193.9 (191.7–196.1) | 46.5 (45.9–47.2) | 117.5 (115.5–119.5) | 131.9 (128.3–135.5) | 147.3 (145.2–149.4) | 4.32 (4.26–4.39) | 2.62 (2.57–2.67) | 4.04 (3.95–4.14) |
P for trend | 0.618 | <0.001 | 0.14 | 0.205 | 0.121 | <0.001 | <0.001 | 0.002 | |
Hypertensive subjects who did not use lipid-lowering medication | |||||||||
2005 | 1230 | 193.1 (191–195.2) | 43.5 (42.8–44.2) | 119.4 (117.5–121.4) | 135.8 (131.3–140.4) | 149.6 (147.6–151.6) | 4.62 (4.55–4.69) | 2.86 (2.81–2.91) | 4.32 (4.18–4.46) |
2008 | 1464 | 196.2 (193.7–198.8) | 46.5 (45.8–47.3) | 120.3 (118.1–122.5) | 130 (125.6–134.5) | 149.7 (147.3–152.1) | 4.39 (4.32–4.46) | 2.7 (2.64–2.76) | 3.99 (3.88–4.12) |
2010 | 1600 | 195.8 (193.5–198.1) | 46.3 (45.6–47) | 119.6 (117.6–121.7) | 132.3 (128.4–136.3) | 149.5 (147.3–151.7) | 4.39 (4.33–4.46) | 2.69 (2.63–2.74) | 4.06 (3.96–4.18) |
P for trend | 0.072 | <0.001 | 0.859 | 0.218 | 0.964 | <0.001 | <0.001 | 0.003 | |
Subjects with diabetes | |||||||||
2005 | 416 | 193 (188.9–197.2) | 41.7 (40.7–42.7) | 119.9 (116–123.7) | 143.4 (136.4–150.7) | 151.4 (147.3–155.5) | 4.8 (4.67–4.93) | 2.99 (2.88–3.09) | 4.62 (4.41–4.84) |
2008 | 583 | 191.7 (187.9–195.5) | 43.6 (42.8–44.5) | 117 (113.8–120.3) | 137.7 (130.9–145) | 148.1 (144.5–151.7) | 4.54 (4.44–4.64) | 2.78 (2.69–2.86) | 4.35 (4.17–4.54) |
2010 | 528 | 186.8 (183.2–190.4) | 44.5 (43.3–45.7) | 111.1 (107.4–114.8) | 137.6 (130–145.6) | 142.3 (138.5–146.2) | 4.37 (4.23–4.51) | 2.60 (2.48–2.72) | 4.32 (4.11–4.54) |
P for trend | 0.033 | <0.001 | 0.002 | 0.268 | 0.002 | <0.001 | <0.001 | 0.045 | |
Diabetic subjects who did not use lipid-lowering medication | |||||||||
2005 | 394 | 193.8 (189.5–198.1) | 41.8 (40.7–42.8) | 120.3 (116.2–124.4) | 143.9 (136.5–151.8) | 152 (147.7–156.2) | 4.81 (4.67–4.94) | 2.99 (2.88–3.1) | 4.63 (4.4–4.86) |
2008 | 528 | 192.1 (187.9–196.3) | 43.1 (42.2–44) | 117.9 (114.4–121.5) | 137.7 (130.5–145.3) | 149 (145–152.9) | 4.59 (4.49–4.69) | 2.82 (2.74–2.91) | 4.38 (4.19–4.58) |
2010 | 428 | 190.1 (185.9–194.2) | 44.6 (43.3–45.9) | 114.6 (110.4–118.8) | 137.2 (128.3–146.8) | 145.5 (140.9–150) | 4.45 (4.28–4.62) | 2.69 (2.55–2.83) | 4.31 (4.05–4.57) |
P for trend | 0.236 | 0.001 | 0.061 | 0.239 | 0.042 | <0.001 | <0.001 | 0.058 | |
Subjects with obesity | |||||||||
2005 | 3539 | 181 (179.6–182.4) | 46.4 (46–46.8) | 112.2 (111–113.4) | 100 (97.8–102.2) | 134.6 (133.3–135.8) | 4.06 (4.02–4.09) | 2.53 (2.5–2.56) | 3.31 (3.25–3.37) |
2008 | 4238 | 183 (181.7–184.3) | 49.7 (49.3–50.2) | 111.1 (109.9–112.2) | 96.8 (95.2–98.5) | 133.3 (132–134.6) | 3.84 (3.8–3.87) | 2.34 (2.31–2.37) | 3.12 (3.07–3.16) |
2010 | 3879 | 183.6 (182.4–284.9) | 50.2 (49.7–50.6) | 111.5 (110.3–112.6) | 95.4 (93.3–97.6) | 133.5 (132.2–134.7) | 3.81 (3.77–3.85) | 2.33 (2.3–2.36) | 3.07 (3.01–3.13) |
P for trend | 0.005 | <0.001 | 0.326 | 0.004 | 0.184 | <0.001 | <0.001 | <0.001 | |
Obese subjects who did not use lipid-lowering medication | |||||||||
2005 | 3509 | 180.8 (179.4–182.2) | 46.1 (45.7–46.6) | 112.1 (110.8–113.3) | 101.1 (98.8–103.4) | 134.7 (133.4–136) | 4.08 (4.04–4.11) | 2.54 (2.51–2.57) | 3.34 (3.28–3.41) |
2008 | 4142 | 182.9 (181.5–184.2) | 49.4 (48.9–49.9) | 111.1 (109.9–112.2) | 97.7 (96–99.4) | 133.5 (132.2–134.7) | 3.86 (3.82–3.9) | 2.36 (2.33–2.39) | 3.15 (3.1–3.2) |
2010 | 3721 | 184 (182.7–185.3) | 49.9 (49.4–50.4) | 111.9 (110.8–113.1) | 96.2 (93.8–98.5) | 134.1 (132.8–135.4) | 3.84 (3.8–3.89) | 2.35 (2.32–2.39) | 3.1 (3.03–3.16) |
P for trend | <0.001 | <0.001 | 0.751 | 0.003 | 0.435 | <0.001 | <0.001 | <0.001 |
. | n . | TC . | HDL-C . | LDL-C . | TG . | Non-HDL-C . | TC/HDL-C . | LDL-C/HDL-C . | TG/HDL-C . |
---|---|---|---|---|---|---|---|---|---|
Subjects with hypertension | |||||||||
2005 | 1277 | 193.2 (191.1–195.2) | 43.6 (42.9–44.2) | 119.6 (117.7–121.5) | 135.4 (131–140) | 149.6 (147.6–151.6) | 4.61 (4.54–4.68) | 2.86 (2.81–2.91) | 4.3 (4.17–4.44) |
2008 | 1601 | 195 (192.6–197.4) | 46.7 (46–47.4) | 118.9 (116.7–121.1) | 129.8 (125.5–134.2) | 148.3 (145.9–150.6) | 4.35 (4.28–4.42) | 2.66 (2.6–2.72) | 3.98 (3.87–4.1) |
2010 | 1822 | 193.9 (191.7–196.1) | 46.5 (45.9–47.2) | 117.5 (115.5–119.5) | 131.9 (128.3–135.5) | 147.3 (145.2–149.4) | 4.32 (4.26–4.39) | 2.62 (2.57–2.67) | 4.04 (3.95–4.14) |
P for trend | 0.618 | <0.001 | 0.14 | 0.205 | 0.121 | <0.001 | <0.001 | 0.002 | |
Hypertensive subjects who did not use lipid-lowering medication | |||||||||
2005 | 1230 | 193.1 (191–195.2) | 43.5 (42.8–44.2) | 119.4 (117.5–121.4) | 135.8 (131.3–140.4) | 149.6 (147.6–151.6) | 4.62 (4.55–4.69) | 2.86 (2.81–2.91) | 4.32 (4.18–4.46) |
2008 | 1464 | 196.2 (193.7–198.8) | 46.5 (45.8–47.3) | 120.3 (118.1–122.5) | 130 (125.6–134.5) | 149.7 (147.3–152.1) | 4.39 (4.32–4.46) | 2.7 (2.64–2.76) | 3.99 (3.88–4.12) |
2010 | 1600 | 195.8 (193.5–198.1) | 46.3 (45.6–47) | 119.6 (117.6–121.7) | 132.3 (128.4–136.3) | 149.5 (147.3–151.7) | 4.39 (4.33–4.46) | 2.69 (2.63–2.74) | 4.06 (3.96–4.18) |
P for trend | 0.072 | <0.001 | 0.859 | 0.218 | 0.964 | <0.001 | <0.001 | 0.003 | |
Subjects with diabetes | |||||||||
2005 | 416 | 193 (188.9–197.2) | 41.7 (40.7–42.7) | 119.9 (116–123.7) | 143.4 (136.4–150.7) | 151.4 (147.3–155.5) | 4.8 (4.67–4.93) | 2.99 (2.88–3.09) | 4.62 (4.41–4.84) |
2008 | 583 | 191.7 (187.9–195.5) | 43.6 (42.8–44.5) | 117 (113.8–120.3) | 137.7 (130.9–145) | 148.1 (144.5–151.7) | 4.54 (4.44–4.64) | 2.78 (2.69–2.86) | 4.35 (4.17–4.54) |
2010 | 528 | 186.8 (183.2–190.4) | 44.5 (43.3–45.7) | 111.1 (107.4–114.8) | 137.6 (130–145.6) | 142.3 (138.5–146.2) | 4.37 (4.23–4.51) | 2.60 (2.48–2.72) | 4.32 (4.11–4.54) |
P for trend | 0.033 | <0.001 | 0.002 | 0.268 | 0.002 | <0.001 | <0.001 | 0.045 | |
Diabetic subjects who did not use lipid-lowering medication | |||||||||
2005 | 394 | 193.8 (189.5–198.1) | 41.8 (40.7–42.8) | 120.3 (116.2–124.4) | 143.9 (136.5–151.8) | 152 (147.7–156.2) | 4.81 (4.67–4.94) | 2.99 (2.88–3.1) | 4.63 (4.4–4.86) |
2008 | 528 | 192.1 (187.9–196.3) | 43.1 (42.2–44) | 117.9 (114.4–121.5) | 137.7 (130.5–145.3) | 149 (145–152.9) | 4.59 (4.49–4.69) | 2.82 (2.74–2.91) | 4.38 (4.19–4.58) |
2010 | 428 | 190.1 (185.9–194.2) | 44.6 (43.3–45.9) | 114.6 (110.4–118.8) | 137.2 (128.3–146.8) | 145.5 (140.9–150) | 4.45 (4.28–4.62) | 2.69 (2.55–2.83) | 4.31 (4.05–4.57) |
P for trend | 0.236 | 0.001 | 0.061 | 0.239 | 0.042 | <0.001 | <0.001 | 0.058 | |
Subjects with obesity | |||||||||
2005 | 3539 | 181 (179.6–182.4) | 46.4 (46–46.8) | 112.2 (111–113.4) | 100 (97.8–102.2) | 134.6 (133.3–135.8) | 4.06 (4.02–4.09) | 2.53 (2.5–2.56) | 3.31 (3.25–3.37) |
2008 | 4238 | 183 (181.7–184.3) | 49.7 (49.3–50.2) | 111.1 (109.9–112.2) | 96.8 (95.2–98.5) | 133.3 (132–134.6) | 3.84 (3.8–3.87) | 2.34 (2.31–2.37) | 3.12 (3.07–3.16) |
2010 | 3879 | 183.6 (182.4–284.9) | 50.2 (49.7–50.6) | 111.5 (110.3–112.6) | 95.4 (93.3–97.6) | 133.5 (132.2–134.7) | 3.81 (3.77–3.85) | 2.33 (2.3–2.36) | 3.07 (3.01–3.13) |
P for trend | 0.005 | <0.001 | 0.326 | 0.004 | 0.184 | <0.001 | <0.001 | <0.001 | |
Obese subjects who did not use lipid-lowering medication | |||||||||
2005 | 3509 | 180.8 (179.4–182.2) | 46.1 (45.7–46.6) | 112.1 (110.8–113.3) | 101.1 (98.8–103.4) | 134.7 (133.4–136) | 4.08 (4.04–4.11) | 2.54 (2.51–2.57) | 3.34 (3.28–3.41) |
2008 | 4142 | 182.9 (181.5–184.2) | 49.4 (48.9–49.9) | 111.1 (109.9–112.2) | 97.7 (96–99.4) | 133.5 (132.2–134.7) | 3.86 (3.82–3.9) | 2.36 (2.33–2.39) | 3.15 (3.1–3.2) |
2010 | 3721 | 184 (182.7–185.3) | 49.9 (49.4–50.4) | 111.9 (110.8–113.1) | 96.2 (93.8–98.5) | 134.1 (132.8–135.4) | 3.84 (3.8–3.89) | 2.35 (2.32–2.39) | 3.1 (3.03–3.16) |
P for trend | <0.001 | <0.001 | 0.751 | 0.003 | 0.435 | <0.001 | <0.001 | <0.001 |
TC, total cholesterol; TG, triglycerides; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol. Data are presented as mean ± 95% confidence intervals. The P for trend was estimated using a general linear model.
. | n . | TC . | HDL-C . | LDL-C . | TG . | Non-HDL-C . | TC/HDL-C . | LDL-C/HDL-C . | TG/HDL-C . |
---|---|---|---|---|---|---|---|---|---|
Subjects with hypertension | |||||||||
2005 | 1277 | 193.2 (191.1–195.2) | 43.6 (42.9–44.2) | 119.6 (117.7–121.5) | 135.4 (131–140) | 149.6 (147.6–151.6) | 4.61 (4.54–4.68) | 2.86 (2.81–2.91) | 4.3 (4.17–4.44) |
2008 | 1601 | 195 (192.6–197.4) | 46.7 (46–47.4) | 118.9 (116.7–121.1) | 129.8 (125.5–134.2) | 148.3 (145.9–150.6) | 4.35 (4.28–4.42) | 2.66 (2.6–2.72) | 3.98 (3.87–4.1) |
2010 | 1822 | 193.9 (191.7–196.1) | 46.5 (45.9–47.2) | 117.5 (115.5–119.5) | 131.9 (128.3–135.5) | 147.3 (145.2–149.4) | 4.32 (4.26–4.39) | 2.62 (2.57–2.67) | 4.04 (3.95–4.14) |
P for trend | 0.618 | <0.001 | 0.14 | 0.205 | 0.121 | <0.001 | <0.001 | 0.002 | |
Hypertensive subjects who did not use lipid-lowering medication | |||||||||
2005 | 1230 | 193.1 (191–195.2) | 43.5 (42.8–44.2) | 119.4 (117.5–121.4) | 135.8 (131.3–140.4) | 149.6 (147.6–151.6) | 4.62 (4.55–4.69) | 2.86 (2.81–2.91) | 4.32 (4.18–4.46) |
2008 | 1464 | 196.2 (193.7–198.8) | 46.5 (45.8–47.3) | 120.3 (118.1–122.5) | 130 (125.6–134.5) | 149.7 (147.3–152.1) | 4.39 (4.32–4.46) | 2.7 (2.64–2.76) | 3.99 (3.88–4.12) |
2010 | 1600 | 195.8 (193.5–198.1) | 46.3 (45.6–47) | 119.6 (117.6–121.7) | 132.3 (128.4–136.3) | 149.5 (147.3–151.7) | 4.39 (4.33–4.46) | 2.69 (2.63–2.74) | 4.06 (3.96–4.18) |
P for trend | 0.072 | <0.001 | 0.859 | 0.218 | 0.964 | <0.001 | <0.001 | 0.003 | |
Subjects with diabetes | |||||||||
2005 | 416 | 193 (188.9–197.2) | 41.7 (40.7–42.7) | 119.9 (116–123.7) | 143.4 (136.4–150.7) | 151.4 (147.3–155.5) | 4.8 (4.67–4.93) | 2.99 (2.88–3.09) | 4.62 (4.41–4.84) |
2008 | 583 | 191.7 (187.9–195.5) | 43.6 (42.8–44.5) | 117 (113.8–120.3) | 137.7 (130.9–145) | 148.1 (144.5–151.7) | 4.54 (4.44–4.64) | 2.78 (2.69–2.86) | 4.35 (4.17–4.54) |
2010 | 528 | 186.8 (183.2–190.4) | 44.5 (43.3–45.7) | 111.1 (107.4–114.8) | 137.6 (130–145.6) | 142.3 (138.5–146.2) | 4.37 (4.23–4.51) | 2.60 (2.48–2.72) | 4.32 (4.11–4.54) |
P for trend | 0.033 | <0.001 | 0.002 | 0.268 | 0.002 | <0.001 | <0.001 | 0.045 | |
Diabetic subjects who did not use lipid-lowering medication | |||||||||
2005 | 394 | 193.8 (189.5–198.1) | 41.8 (40.7–42.8) | 120.3 (116.2–124.4) | 143.9 (136.5–151.8) | 152 (147.7–156.2) | 4.81 (4.67–4.94) | 2.99 (2.88–3.1) | 4.63 (4.4–4.86) |
2008 | 528 | 192.1 (187.9–196.3) | 43.1 (42.2–44) | 117.9 (114.4–121.5) | 137.7 (130.5–145.3) | 149 (145–152.9) | 4.59 (4.49–4.69) | 2.82 (2.74–2.91) | 4.38 (4.19–4.58) |
2010 | 428 | 190.1 (185.9–194.2) | 44.6 (43.3–45.9) | 114.6 (110.4–118.8) | 137.2 (128.3–146.8) | 145.5 (140.9–150) | 4.45 (4.28–4.62) | 2.69 (2.55–2.83) | 4.31 (4.05–4.57) |
P for trend | 0.236 | 0.001 | 0.061 | 0.239 | 0.042 | <0.001 | <0.001 | 0.058 | |
Subjects with obesity | |||||||||
2005 | 3539 | 181 (179.6–182.4) | 46.4 (46–46.8) | 112.2 (111–113.4) | 100 (97.8–102.2) | 134.6 (133.3–135.8) | 4.06 (4.02–4.09) | 2.53 (2.5–2.56) | 3.31 (3.25–3.37) |
2008 | 4238 | 183 (181.7–184.3) | 49.7 (49.3–50.2) | 111.1 (109.9–112.2) | 96.8 (95.2–98.5) | 133.3 (132–134.6) | 3.84 (3.8–3.87) | 2.34 (2.31–2.37) | 3.12 (3.07–3.16) |
2010 | 3879 | 183.6 (182.4–284.9) | 50.2 (49.7–50.6) | 111.5 (110.3–112.6) | 95.4 (93.3–97.6) | 133.5 (132.2–134.7) | 3.81 (3.77–3.85) | 2.33 (2.3–2.36) | 3.07 (3.01–3.13) |
P for trend | 0.005 | <0.001 | 0.326 | 0.004 | 0.184 | <0.001 | <0.001 | <0.001 | |
Obese subjects who did not use lipid-lowering medication | |||||||||
2005 | 3509 | 180.8 (179.4–182.2) | 46.1 (45.7–46.6) | 112.1 (110.8–113.3) | 101.1 (98.8–103.4) | 134.7 (133.4–136) | 4.08 (4.04–4.11) | 2.54 (2.51–2.57) | 3.34 (3.28–3.41) |
2008 | 4142 | 182.9 (181.5–184.2) | 49.4 (48.9–49.9) | 111.1 (109.9–112.2) | 97.7 (96–99.4) | 133.5 (132.2–134.7) | 3.86 (3.82–3.9) | 2.36 (2.33–2.39) | 3.15 (3.1–3.2) |
2010 | 3721 | 184 (182.7–185.3) | 49.9 (49.4–50.4) | 111.9 (110.8–113.1) | 96.2 (93.8–98.5) | 134.1 (132.8–135.4) | 3.84 (3.8–3.89) | 2.35 (2.32–2.39) | 3.1 (3.03–3.16) |
P for trend | <0.001 | <0.001 | 0.751 | 0.003 | 0.435 | <0.001 | <0.001 | <0.001 |
. | n . | TC . | HDL-C . | LDL-C . | TG . | Non-HDL-C . | TC/HDL-C . | LDL-C/HDL-C . | TG/HDL-C . |
---|---|---|---|---|---|---|---|---|---|
Subjects with hypertension | |||||||||
2005 | 1277 | 193.2 (191.1–195.2) | 43.6 (42.9–44.2) | 119.6 (117.7–121.5) | 135.4 (131–140) | 149.6 (147.6–151.6) | 4.61 (4.54–4.68) | 2.86 (2.81–2.91) | 4.3 (4.17–4.44) |
2008 | 1601 | 195 (192.6–197.4) | 46.7 (46–47.4) | 118.9 (116.7–121.1) | 129.8 (125.5–134.2) | 148.3 (145.9–150.6) | 4.35 (4.28–4.42) | 2.66 (2.6–2.72) | 3.98 (3.87–4.1) |
2010 | 1822 | 193.9 (191.7–196.1) | 46.5 (45.9–47.2) | 117.5 (115.5–119.5) | 131.9 (128.3–135.5) | 147.3 (145.2–149.4) | 4.32 (4.26–4.39) | 2.62 (2.57–2.67) | 4.04 (3.95–4.14) |
P for trend | 0.618 | <0.001 | 0.14 | 0.205 | 0.121 | <0.001 | <0.001 | 0.002 | |
Hypertensive subjects who did not use lipid-lowering medication | |||||||||
2005 | 1230 | 193.1 (191–195.2) | 43.5 (42.8–44.2) | 119.4 (117.5–121.4) | 135.8 (131.3–140.4) | 149.6 (147.6–151.6) | 4.62 (4.55–4.69) | 2.86 (2.81–2.91) | 4.32 (4.18–4.46) |
2008 | 1464 | 196.2 (193.7–198.8) | 46.5 (45.8–47.3) | 120.3 (118.1–122.5) | 130 (125.6–134.5) | 149.7 (147.3–152.1) | 4.39 (4.32–4.46) | 2.7 (2.64–2.76) | 3.99 (3.88–4.12) |
2010 | 1600 | 195.8 (193.5–198.1) | 46.3 (45.6–47) | 119.6 (117.6–121.7) | 132.3 (128.4–136.3) | 149.5 (147.3–151.7) | 4.39 (4.33–4.46) | 2.69 (2.63–2.74) | 4.06 (3.96–4.18) |
P for trend | 0.072 | <0.001 | 0.859 | 0.218 | 0.964 | <0.001 | <0.001 | 0.003 | |
Subjects with diabetes | |||||||||
2005 | 416 | 193 (188.9–197.2) | 41.7 (40.7–42.7) | 119.9 (116–123.7) | 143.4 (136.4–150.7) | 151.4 (147.3–155.5) | 4.8 (4.67–4.93) | 2.99 (2.88–3.09) | 4.62 (4.41–4.84) |
2008 | 583 | 191.7 (187.9–195.5) | 43.6 (42.8–44.5) | 117 (113.8–120.3) | 137.7 (130.9–145) | 148.1 (144.5–151.7) | 4.54 (4.44–4.64) | 2.78 (2.69–2.86) | 4.35 (4.17–4.54) |
2010 | 528 | 186.8 (183.2–190.4) | 44.5 (43.3–45.7) | 111.1 (107.4–114.8) | 137.6 (130–145.6) | 142.3 (138.5–146.2) | 4.37 (4.23–4.51) | 2.60 (2.48–2.72) | 4.32 (4.11–4.54) |
P for trend | 0.033 | <0.001 | 0.002 | 0.268 | 0.002 | <0.001 | <0.001 | 0.045 | |
Diabetic subjects who did not use lipid-lowering medication | |||||||||
2005 | 394 | 193.8 (189.5–198.1) | 41.8 (40.7–42.8) | 120.3 (116.2–124.4) | 143.9 (136.5–151.8) | 152 (147.7–156.2) | 4.81 (4.67–4.94) | 2.99 (2.88–3.1) | 4.63 (4.4–4.86) |
2008 | 528 | 192.1 (187.9–196.3) | 43.1 (42.2–44) | 117.9 (114.4–121.5) | 137.7 (130.5–145.3) | 149 (145–152.9) | 4.59 (4.49–4.69) | 2.82 (2.74–2.91) | 4.38 (4.19–4.58) |
2010 | 428 | 190.1 (185.9–194.2) | 44.6 (43.3–45.9) | 114.6 (110.4–118.8) | 137.2 (128.3–146.8) | 145.5 (140.9–150) | 4.45 (4.28–4.62) | 2.69 (2.55–2.83) | 4.31 (4.05–4.57) |
P for trend | 0.236 | 0.001 | 0.061 | 0.239 | 0.042 | <0.001 | <0.001 | 0.058 | |
Subjects with obesity | |||||||||
2005 | 3539 | 181 (179.6–182.4) | 46.4 (46–46.8) | 112.2 (111–113.4) | 100 (97.8–102.2) | 134.6 (133.3–135.8) | 4.06 (4.02–4.09) | 2.53 (2.5–2.56) | 3.31 (3.25–3.37) |
2008 | 4238 | 183 (181.7–184.3) | 49.7 (49.3–50.2) | 111.1 (109.9–112.2) | 96.8 (95.2–98.5) | 133.3 (132–134.6) | 3.84 (3.8–3.87) | 2.34 (2.31–2.37) | 3.12 (3.07–3.16) |
2010 | 3879 | 183.6 (182.4–284.9) | 50.2 (49.7–50.6) | 111.5 (110.3–112.6) | 95.4 (93.3–97.6) | 133.5 (132.2–134.7) | 3.81 (3.77–3.85) | 2.33 (2.3–2.36) | 3.07 (3.01–3.13) |
P for trend | 0.005 | <0.001 | 0.326 | 0.004 | 0.184 | <0.001 | <0.001 | <0.001 | |
Obese subjects who did not use lipid-lowering medication | |||||||||
2005 | 3509 | 180.8 (179.4–182.2) | 46.1 (45.7–46.6) | 112.1 (110.8–113.3) | 101.1 (98.8–103.4) | 134.7 (133.4–136) | 4.08 (4.04–4.11) | 2.54 (2.51–2.57) | 3.34 (3.28–3.41) |
2008 | 4142 | 182.9 (181.5–184.2) | 49.4 (48.9–49.9) | 111.1 (109.9–112.2) | 97.7 (96–99.4) | 133.5 (132.2–134.7) | 3.86 (3.82–3.9) | 2.36 (2.33–2.39) | 3.15 (3.1–3.2) |
2010 | 3721 | 184 (182.7–185.3) | 49.9 (49.4–50.4) | 111.9 (110.8–113.1) | 96.2 (93.8–98.5) | 134.1 (132.8–135.4) | 3.84 (3.8–3.89) | 2.35 (2.32–2.39) | 3.1 (3.03–3.16) |
P for trend | <0.001 | <0.001 | 0.751 | 0.003 | 0.435 | <0.001 | <0.001 | <0.001 |
TC, total cholesterol; TG, triglycerides; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol. Data are presented as mean ± 95% confidence intervals. The P for trend was estimated using a general linear model.
In subjects with diabetes, there were linearly decreasing trends in age- and sex-adjusted mean TC, LDL-C and non-HDL-C levels and TC/HDL-C, LDL-C/HDL-C and TG/HDL-C ratios and the age- and sex-adjusted mean HDL-C level increased significantly from 2005 to 2008 and to 2010. Among diabetic subjects not taking lipid-lowering medication, there were also decreasing trends in age- and sex-adjusted mean non-HDL-C level and TC/HDL-C and LDL-C/HDL-C ratios, and age- and sex-adjusted mean HDL-C levels increased linearly over the study period.
In the obesity group, there were linearly decreasing trends in age- and sex-adjusted geometric means of TG and TG/HDL-C ratio and means of TC/HDL-C and LDL-C/HDL-C ratios. Age- and sex-adjusted mean TC and HDL-C levels increased linearly within the group. Similar trends over this period occurred in obese subjects who did not use lipid-lowering medication.
Discussion
Main findings of this study
From 2005 to 2008 and to 2010, there was a declining trend in the prevalence of dyslipidemia, and the rates of use of lipid-lowering medication increased linearly for Korean adults overall, for men and for women. Slightly increasing trends in the age-adjusted mean TC level were observed in both Korean men and women. However, the mean TC level has continued to be <200 mg/dl in both sexes. The age-adjusted mean HDL-C level increased linearly in both Korean men and women during the same period. There were no significant changes in age-adjusted mean LDL-C level in both sexes, and the level was slightly >100 mg/dl over the 6-year study period. The age-adjusted geometric mean TG level did not change in men but was in a declining trend for women. There were significantly decreasing trends in age-adjusted mean lipid-related ratios in both men and women. In addition, similar patterns in the age- and sex-adjusted mean TC and HDL-C levels and lipid ratios were observed in Korean adults not taking lipid-lowering medication. The favorable trends were also observed in subjects with hypertension, diabetes or obesity irrespective of the lipid-lowering medication use.
What is already known on this topic
Declines in TC and LDL-C levels have been recently noted in developed countries such as North America, Western countries and Australasia.20,21 In the USA between 1988 and 2010, although the age-adjusted mean TC, LDL-C, TG and non-HDL-C levels were still higher than those in South Korea, the mean TC, LDL-C and non-HDL-C levels decreased and the mean HDL-C level increased linearly. In addition, the trends among American adults not receiving lipid-lowering medication were similar to those for adults overall.22 The continuously ongoing efforts to lower cholesterol levels in the USA made these favorable trends in lipids and lipoproteins and decreased the risk of CVD.
Among Korean adults, hypo-HDL-cholesterolemia and hypertriglyceridemia were previously reported as dominant subtypes of dyslipidemia and were considered to be caused by a carbohydrate-centered diet and correlated with an increased prevalence of obesity and diabetes.16,23,24
What this study adds
Compared with a previous study, notable changes in lipid profiles for Korean adults over this period were favorable trends in HDL-C level and lipid ratios and lowered TG level in women. The changes in HDL-C levels observed in this study may be more attributable to changes in lifestyle than an increasing tendency to use lipid-lowering medication given that similar trends continued in those who did not use lipid-lowering medication. In addition to genetic factors, various environmental factors such as alcohol consumption, cigarette smoking, physical activity and dietary components are determinants of HDL-C level. Studies have shown that moderate alcohol consumption increases and cigarette smoking decreases HDL-C levels.25,26 Increased physical activity is known to be associated with higher HDL-C level.26 A moderate-fat diet in comparison with a low-fat diet has been shown to raise the serum HDL-C level, and a polyunsaturated fat-rich diet or a low-glycemic-index carbohydrate diet may also improve the HDL-C profile.26,27 The rate of current smoking in Korean men decreased from 51.6% in 2005 to 48.3% in 2010. The drinking rate for a month showed increasing tendency in both sexes, but high-risk alcohol drinking rate did not show linear changes in the same period. The proportions of total fat or carbohydrate intakes of total calories in Korean adults were not changed significantly within the period. The rate of physical activity with more than moderate degree showed decreasing trends in the period.28 In light of declining trends in mean lipid-related ratios, favorable lifestyle changes such as decreased current smoking rate appear to be more contributable to increasing trend in HDL-C level because undesirable lifestyle changes such as increased drinking rate or decreased physical activity can also elevate the TC, LDL-C and TG levels.
Another noteworthy point from the present study was the improving trend in the TG level in female subjects over the survey years. Both overall and abdominal adiposity are strongly associated with hypertriglyceridemia,23 and the trend in the TG level correlates with the secular trend in the prevalence of obesity in Korean women, which decreased in the younger- and middle-aged subgroups but increased in the older subgroup. These trends seem to be influenced by the increased participation of Korean women in socioeconomic activity, the consequent rise in age at marriage and a lowered birth rate, and the social preference for thin women.29 Additionally, the mean TC, LDL-C, TG and non-HDL-C levels and lipid ratios in women older than 65 years of age were higher than those in men of the same age. The possible cause is thought to be caused by hormonal effects. Premenopausal women have lower lipid levels than men of the same age but lipid levels in postmenopausal women increase and become higher than those of men.24
Meanwhile, there were also favorable trends in some lipid profiles in subgroups of subjects, such as those with hypertension, diabetes and obesity. These patterns persisted among subjects who did not take lipid-lowering medication in each subgroup. All of the trends in each subgroup are consistent with the improvement in awareness and control rate of cardiovascular risk factors from 1998 to 2007 in South Korea.30 However, control remains inadequate, especially in diabetic patients, who had an LDL-C level >100 mg/dl. Hypertension, diabetes and obesity are substantial risk factors for CHD, and they enhance the morbidity and mortality of CVD with uncontrolled dyslipidemia.31,32 Therefore, serum lipid and lipoprotein levels in subjects with diabetes and hypertension should be controlled strictly to prevent macrovascular or microvascular complications.33,34
Limitations of this study
The present study has several limitations. Our analysis was based on data from 3 years of the KNHANES over a 6-year period. The specific types of lipid-lowering medication could not be investigated because only self-reported data for use of any lipid-lowering medication were collected. We could not consider the effect of genetic factors on lipid profiles, and we had limited data for the impact of lifestyle factors on the lipid profiles in the same survey period. Despite these limitations, as nationally representative data, the KNHANES enables us to evaluate the accurate health status of contemporary Koreans as a single ethnicity. Further data from following surveys are needed to confirm these trends, and further research is warranted to investigate simultaneously the effects of various lifestyle factors.
Conclusion
Based on data from the 2005, 2008 and 2010 KNHANES, there was a decrease in the prevalence of dyslipidemia and an increase in the use of lipid-lowering medication in Korean adults. Favorable trends in HDL-C level and lipid-related ratios in both men and women and in TG level in women were observed among South Korean population, and these trends were consistent even in subjects who were not treated with lipid-lowering medication. Although favorable trends were also observed in subjects with hypertension, diabetes or obesity, not all of the lipid profiles showed a favorable tendency in these subgroups. These findings suggest that more intense strategies are needed to control dyslipidemia and prevent future cardiovascular risk.
Funding
None.
References