Trends of LDL/HDL cholesterol ratio levels among US 6-80: National Health and Nutrition Examination Survey (NHANES) 2005-2020

Research Objectives: The LDL/HDL cholesterol ratio is a biomarker of the risk of coronary heart disease. This study aimed to examine the trends and differences in serum low-density lipoprotein cholesterol-to-high density lipoprotein cholesterol (LDL/HDL-C) ratio among U.S. residents by survey years, selected demographic, and socioeconomic variables.

Design: This is an observational study.

Setting: General community.

Participants: Blood lipid measurements, taken from 21,850 noninstitutionalized participants, aged 6 to 80, were obtained from the National Health and Nutrition Examination Survey (NHANES) study. We described the distributions of LDL/HDL-C ratio across the life span in four distinct cross-sectional surveys during 2005-2008, 2009-2012, 2013-2016, and 2017-2020, and compared the ratio levels by race/ethnicity, education level, ratio of income to poverty, body mass index (BMI), and general health condition.

Interventions: N/A

Main Outcome Measures: Blood lipid measurements.

Results: The LDL/HDL-C ratio levels varied by sex and age. Between 2005 and 2020, favorable trends in lipid ratio levels were observed. Overall, non-Hispanic black individuals tended to have lower mean LDL/HDL-C ratio levels than other groups, while Mexican American and other Hispanic individuals tended to have higher LDL/HDL-C ratio levels on average. Being male, having a lower educational level, being obese or having a higher BMI, and reporting poor or fair health status were associated with higher LDL/HDL-C ratio levels. In females, income lower than the poverty level was associated with higher LDL/HDL-C levels. However, there was no difference in LDL/HDL-C levels in males by poverty level.

Conclusions: Between 2005 and 2020, favorable trends in LDL/HDL-C values were observed among noninstitutionalized residents in the US. Targeted educational efforts are warranted to enhance knowledge of personal risk indicators.

Author(s) Disclosures: The authors declare no conflict of interest.