1 Overview

Suggested citation:  Endocrine Society. Endocrine Facts and Figures: Cardiovascular and Lipids. First Edition. 2015

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Cardiovascular and lipid disorders are the leading cause of mortality in the United States (US).1 This chapter focuses on the epidemiology and trends data of hypercholesterolemia and hypertriglyceridemia, conditions that can considerably increase the risk of developing cardiovascular disorders (CVDs).

1.1 Epidemiology

Table 1 summarizes the prevalence of cardiovascular and lipid disorders covered in this chapter. Data from NHANES 2003-2006 reported that in the US 53% of adults age ≥20 years had abnormal lipid profiles.4,5 Table 2 presents detailed information on the prevalence of abnormal lipid profiles in the civilian, non-institutionalized, adult population in the US.

Table 1. Prevalence of adult overweight and obesity in the United States.
Condition Data Source Method Population Prevalance Reference
Hypercholesterolemia NHANES 1999-2006 Cross-sectional survey US, age ≥20 years (n=18,053) 53-56 Ford et al. 20102
Hypertriglyceridemia NHANES 2001-2004, 2009-2012 Cross-sectional survey US, age ≥20 years (n=4,881) 25-33 Carroll et al. 20153

Abbreviations: NHANES, National Health and Nutrition Examination Survey; US, United States; hypercholesterolemia defined by total cholesterol levels ≥200 mg/dL; hypertriglyceridemia defined by triglyceride levels ≥150 mg/dL.

Table 2. Prevalence of abnormal lipid profiles in adults, United States.
Data Source Population Abnormal Lipid Profile Prevalance (%)
NHANES 2003-2006 US, adults, age ≥20 years Elevated LDL-C (risk-stratum specific) 27
Depressed HDL-C (males,23 23
Elevated TGs (≥200 mg/dL) 30
Elevated non-HDL-C (≥130 mg/dL) and elevated TG (≥200 mg/dL) 13
Mixed dyslipidemia (elevated LDL-C and depressed HDL-C and/or elevated TGs) 21
Elevated LDL-C and depressed HDL-C and elevated TG 6
Abbreviations: LDL-C, low-density lipoprotein-cholesterol; HDL-C, high-density lipoprotein cholesterol; TG, triglycerides. Fasting blood serum levels are shown.
Source: Tóth et al. 20124

1.2 Cost Burden of Disease

In 2011, CVDs in the US accounted for $195.6 billion in direct costs (physicians and staff, hospital services, prescribed medication and home health care — excluding home nursing), and $124.5 billion in indirect costs (lost productivity due to absenteeism or premature deaths). In addition, indirect medical costs were substantially higher for males, and for those age <65 years (Table 3).6
Table 1. Cost of overall cardiovascular disorders by age and sex in the United States..
Data Source Population  Total costs ($ billions) Direct costs ($ billions) Indirect costs ($ billions)
Household Medical Expenditure Panel Survey 2011, NCHS, and Institute for Health and Aging US, based on 2011 data for cardiovascular disease or stroke SEX
Males 190.4 99.0 91.4
Females 129.7 96.6 33.1
AGE
 >65 years  203.3  96.2 107.1
TOTAL 320.1 195.6 124.5
Abbreviations: NCHS, National Center for Health Statistics.

Source: Mozaffarian et al. 20156

The National Heart, Lung, and Blood Institute (NHLBI) estimated a 28% increase (from $5.9 million to $7.6 million) in the total cost of inpatient cardiovascular operations and procedures between 2000 and 2010.6 In addition, the American Heart Association (AHA) predicts that by 2030, 40.5% of the US population will likely have some form of a CVD, and that the direct cost of treating CVDs will triple from $273 billion in 2010 to $818 billion in 2030; with indirect costs expected to increase from $172 billion to $276 billion in the same time period.7

According to the Household Medical Expenditure Panel Survey (MEPS), National Center for Health Statistics (NCHS), and Institute for Health and Aging, five of the 23 highest direct health expenditures in 2011, in the US, were in the CVD diagnostic group, with heart disease ranking number one (direct health expenditure $116.3 million), and hyperlipidemia ranking number 10 (direct health expenditure $38.9 million). In total, the CVD diagnostic group accounted for $234.4 billion, or 23%, of the $1.02 trillion total direct US health expenditure costs for 2011.6

An observational cohort study in the US, analyzing the 2008 electronic medical records of 108,324 adults (age ≥18 years), estimated that the mean annual direct medical care cost of patients with severe hypertriglyceridemia (TG levels ≥500 mg/dL) was 38% higher per year ($8,567) than for subjects with normal TG levels (<150 mg/dL, $6,186).8 According to an observational cohort study from 2004-2009, by the same lead authors, lowering TG levels by ≥60% in patients (n=808, mean age 55.9 years, 66% male) with severe hypertriglyceridemia (TG ≥500 mg/dL), reduced the mean annual baseline medical costs by $471.9

An observational claims study (2006-2013) monitoring severe hypertriglyceridemia (TG ≥500 mg/dL) in a commercially-insured US adult population of age 46- 48 years (n=29,896), reported healthcare costs (mean all-cause medical and pharmacy costs) to be highest in patients with the highest TG levels: $8,850 in cohort TG ≥1500 mg/dL, $8,747 in cohort 750 ≤ TG and $8,305 in cohort 500 < TG 300% increase in total allcause costs.10

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