What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Dyslipidemia and adverse blood pressure (n=1665). Intervention: Survey period 2011-2012 vs. Survey period 1999-2000. Primary outcome: Adverse concentration of total cholesterol (≥200 mg/dL) (p=0.006).

January 19, 2015Open Access

Prevalence of and Trends in Dyslipidemia and Blood Pressure Among US Children and Adolescents, 1999-2012

Key Result

Between 1999-2000 and 2011-2012, the prevalence of adverse total cholesterol concentrations among US youths decreased from 10.6% to 7.8%, while high or borderline high blood pressure remained stable.

Study Design

Type

Cross-Sectional (n=1,665)

PICO

Population

Dyslipidemia and adverse blood pressure (n=1,665)

Intervention / Comparator

Survey period 2011-2012 vs Survey period 1999-2000

Primary Outcome

Adverse concentration of total cholesterol (≥200 mg/dL), p=0.006

Main Result

Absolute Event Rate: 7.8% vs 10.6%

p-value: p=0.006

Limitations

Changes in assessment of HDL-C concentration and potential for laboratory bias
Caution in interpretation of lipid values based on a single measure
White coat hypertension may increase estimates of borderline high and/or high BP
Reported prevalence of high BP based on a single visit may overestimate the prevalence of hypertension using accepted clinical criteria

Abstract

IMPORTANCE: Recent national data suggest there were improvements in serum lipid concentrations among US children and adolescents between 1988 and 2010 but an increase in or stable blood pressure (BP) during a similar period. OBJECTIVE: To describe the prevalence of and trends in dyslipidemia and adverse BP among US children and adolescents. DESIGN: The National Health and Nutrition Examination Survey, a cross-sectional survey. SETTING: Noninstitutionalized US population. PARTICIPANTS: Children and adolescents aged 8 to 17 years with measured lipid concentrations (n = 1482) and BP (n = 1665). MAIN OUTCOMES AND MEASURES: Adverse concentrations of total cholesterol (TC) (≥ 200 mg/dL), high-density lipoprotein cholesterol (HDL-C) (<40 mg/dL), and non-HDL-C (≥ 145 mg/dL) (to convert TC, HDL-C, and non-HDL-C to millimoles per liter, multiply by 0.0259) and high or borderline BP were examined. Definitions of BP were informed by the Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents by the National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. Analyses of linear trends in dyslipidemias and BP were conducted overall and separately by sex across 7 periods (1999-2000, 2001-2002, 2003-2004, 2005-2006, 2007-2008, 2009-2010, and 2011-2012). RESULTS: In 2011-2012, 20.2% (95% CI, 16.3-24.6) of youths had an adverse concentration of TC, HDL-C, or non-HDL-C and 11.0% (95% CI, 8.8-13.4) had either high or borderline BP. The prevalences of adverse concentrations decreased between 1999-2000 and 2011-2012 for TC (10.6% 95% CI, 8.3-13.2 vs 7.8% 95% CI, 5.7-10.4; P = .006), HDL-C (17.9% 95% CI, 15.0-21.0 vs 12.8% 95% CI, 9.8-16.2; P = .003), and non-HDL-C (13.6% 95% CI, 11.3-16.2 vs 8.4% 95% CI, 5.9-11.5; P < .001). There was a decrease in high BP between 1999-2000 (3.0% 95% CI, 2.0-4.3) and 2011-2012 (1.6% 95% CI, 1.0-2.4) (P = .003). There was no change from 1999-2000 to 2011-2012 in borderline high BP (7.6% 95% CI, 5.8-9.8 vs 9.4% 95% CI, 7.2-11.9; P = .90) or either high or borderline high BP (10.6% 8.4-13.1 vs 11.0% 95% CI, 8.8-13.4; P = .26). CONCLUSIONS AND RELEVANCE: In 2011-2012, approximately 1 in 5 children and adolescents aged 8 to 17 years had an adverse lipid concentration of TC, HDL-C, or non-HDL-C and slightly more than 1 in 10 had either borderline high or high BP. The prevalence of dyslipidemia modestly decreased between 1999-2000 and 2011-2012, but either high or borderline high BP remained stable. The reasons for these trends require further study.

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