Lipid concentrations and the use of lipid lowering drugs: evidence from a national cross sectional survey

Objective To evaluate the prevalence of the use of lipid lowering agents and its relation to blood lipid concentrations in English adults. Design Cross sectional survey. Setting England, 1998. Participants Nationally representative sample of 13 586 adults (aged greater than or equal to 16 years) living in non-institutional households. Main outcome measures Mean blood concentrations of total cholesterol and high density lipoprotein (HDL) cholesterol, and the ratio of total cholesterol to HDL cholesterol, in participants classified by age and sex; prevalence of raised total cholesterol concentrations and increased ratio of total to HDL cholesterol; prevalence of use of lipid lowering agents and the lipid concentrations of people taking them. Results Mean total cholesterol concentrations were 5.47 (SE 0.02) mmol/l in men and 5.59 (0.02) mmol/l in women. Mean HDL cholesterol concentrations were 1.28 (0.01) mmol/l in men and 1.55 (0.01) mmol/l in women. Overall, of 10 569 adults who had a valid cholesterol measurement taken 7133 (67.5%; 95% confidence interval 66.5% to 68.4%) had a total cholesterol concentration greater than or equal to5 mmol/l, 2804 (26.5%; 25.7% to 27.4%) had a ratio of total cholesterol to HDL cholesterol greater than or equal to5 mmol/l, and 237 (2.2%; 1.9% to 2.5%) reported taking lipid lowering drugs. Of 117 participants with no history of cardiovascular disease but whose estimated 10 year risk of coronary heart disease was greater than or equal to 30% and whose total cholesterol concentration was greater than or equal to5 mmol/l, four (3%) were taking lipid lowering drugs. Of 385 adults aged 16-75 with a history of coronary heart disease and eligible for lipid lowering treatment, 114 (30%; 25%, to 34%) were taking lipid lowering drugs, of whom only 50 (44%; 35% to 53%) had a total cholesterol concentration <5 mmo/l. Conclusions Despite the high prevalence of dyslipidaemia in English adults, the proportion of adults taking lipid lowering drugs in 1998 was only 2.2%. Rates of treatment were low among high risk patients eligible for primary prevention with lipid lowering drugs, and less than one third of patients with established cardiovascular disease received such treatment.