Trends in total and high density lipoprotein cholesterol and their determinants in The Netherlands between 1993 and 1997

Background The aim of this study is to describe trends in plasma total and high density lipoprotein (HDL) cholesterol in The Netherlands between 1993 and 1997 and to examine whether these trends in cholesterol could be explained by changes in body mass index, smoking, alcohol intake, use of cholesterol lowering medication, intake of saturated fat, trans fatty acids and dietary cholesterol. Methods Each year a random sample of men and women aged 20-59 years living in three towns in The Netherlands was invited to participate in the study. In total more than 21 000 people were examined. Results Between 1993 and 1997 plasma total cholesterol decreased significantly by 0.19 mmol/l in men and by 0.27 mmol/l in women. During this period HDL cholesterol remained stable in both men and women. Small decreases were observed in the intake of saturated fat, trans fatty acids and dietary cholesterol in both, men and women. The use of cholesterol lowering medication and for women oral contraceptives and prescribed oestrogens increased significantly. After adjustment for these determinants in multivariate analyses the trend in total cholesterol remained highly significant. Conclusions Between 1993 and 1997 the mean total cholesterol level decreased significantly while the mean HDL cholesterol remained stable in both men and women in The Netherlands. The observed trend in total cholesterol could only for a small part be explained by changes in the determinants studied.