Between October 18–21, this website will move to a new web address (from health.gov to odphp.health.gov). During that time, some functions might not work as expected. We appreciate your patience and understanding as we’re working to make this transition as smooth as possible.

Increase cholesterol treatment in adults — HDS‑07 Data Methodology and Measurement

About the National Data

Data

Baseline: 45.0 percent of eligible adults aged 21 years and over received treatment of blood cholesterol in 2013-16

Target: 55.0 percent

Numerator
Number of adults aged 21 years and over eligible for treatment to lower blood cholesterol who report receiving treatment.
Denominator
Number of adults aged 21 years and over eligible for treatment to lower blood cholesterol.
Target-setting method
Percentage point improvement
Target-setting method details
Percentage point improvement from the baseline using Cohen's h effect size of 0.20.
1
Target-setting method justification
Trend data were not available for this objective. A percentage point improvement was calculated using Cohen's h effect size of 0.2. This method was used because new Cholesterol Guidelines were implemented in November 2013, which had a strong emphasis on Statin use among persons with elevated blood cholesterol levels. As a result, the Healthy People 2030 Workgroup Subject Matter Experts anticipated an increase in cholesterol medications over the next decade.

Methodology

Questions used to obtain the national baseline data

(For additional information, please visit the data source page linked above.)

From the 2013-2014 and 2015-2016 National Health and Nutrition Examination Survey:

Numerator:
[To lower (your/his/her) blood cholesterol, (have/has) (you/SP) ever been told by a doctor or other health professional]… to take prescribed medicine?
  1. Yes
  2. No
  3. Refused
  4. Don't know
(Are you/Is SP) now following this advice to take prescribed medicine?
  1. Yes
  2. No
  3. Refused
  4. Don't know
[NUMERATOR AND DENOMINATOR:]
[GROUP 1 ASCVD:]
Has a doctor or other health professional ever told {you/SP} that {you/s/he} . . .had coronary heart disease?
  1. Yes
  2. No
  3. Refused
  4. Don't know
Has a doctor or other health professional ever told {you/SP} that {you/s/he} . . .had a heart attack (also called myocardial infarction)?
  1. Yes
  2. No
  3. Refused
  4. Don't know
Has a doctor or other health professional ever told {you/SP} that {you/s/he} . . .had a stroke?
  1. Yes
  2. No
  3. Refused
  4. Don't know
Has a doctor or other health professional ever told {you/SP} that {you/s/he} . . .had angina, also called angina pectoris?
  1. Yes
  2. No
  3. Refused
  4. Don't know

Rose Quesionnaire (following 7 questions), for persons aged 40 years and over:

{Have you/Has SP} ever had any pain or discomfort in {your/her/his} chest?
  1. Yes
  2. No
  3. Refused
  4. Don't know
{Do you/Does she/Does he} get it when {you/she/he} walk uphill or hurry?
  1. Yes
  2. No
  3. Never walks uphill or hurries
  4. Refused
  5. Don't know
{Do you/Does she/Does he} get it when {you/she/he} walk at an ordinary pace on level ground?
  1. Yes
  2. No
  3. Refused
  4. Don't know
What {do you/does she/does he} do if {you/she/he} get it while {you/she/he} are walking? {Do you/Does she/Does he} stop or slow down or continue at the same pace?
  1. Stop or slow down
  2. Continue at the same pace
  3. Refused
  4. Don't know
If {you/she/he} stand still, what happens to it? Is the pain or discomfort relieved or not relieved?
  1. Relieved
  2. Not Relieved
  3. Refused
  4. Don't know
How soon is the pain relieved? Would you say…
  1. 10 minutes or less
  2. More than 10 minutes
  3. Refused
  4. Don't know
Please look at this card and show me where the pain or discomfort is located.
  1. Pain in right arm
  2. Pain in right chest
  3. Pain in neck
  4. Pain in upper sternum
  5. Pain in lower sternum
  6. Pain in left chest
  7. Pain in left arm
  8. Pain in epigastric area
[GROUP 3 DIABETES:]
{Other than during pregnancy, {have you/has SP}/{Have you/Has SP}} ever been told by a doctor or health professional that {you have/{he/she/SP} has} diabetes or sugar diabetes?
  1. Yes
  2. No
  3. Borderline
  4. Refused
  5. Don't know
{Is SP/Are you} now taking insulin?
  1. Yes
  2. No
  3. Refused
  4. Don't know
{Is SP/Are you} now taking diabetic pills to lower {{his/her}/your} blood sugar?
  1. Yes
  2. No
  3. Refused
  4. Don't know

Methodology notes

Includes non-pregnant fasting adults ≥21 years for whom a statin is recommended, based on their risk for atherosclerotic cardiovascular disease (ASCVD), as defined by the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines. (Stone NJ, Robinson J, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, Goldberg AC, Gordon D, Levy D, Lloyd-Jones DM, McBride P, Schwartz JS, Shero ST, Smith SC Jr, Watson K, Wilson PWF. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2013; 129 [suppl 2]:S1-S45.)

Those eligible for statin therapy were captured in 4 groups:

  1. Clinical ASCVD: Moderate-intensity statin therapy recommended for those aged >75 years; High-intensity statin therapy recommended for those aged 21-75 years. Clinical ASCVD is defined by health care professional's diagnosis of angina, coronary heart disease, heart attack, or stroke or meeting the criteria for grade 1 or grade 2 angina by the Rose questionnaire assessment. The Rose questionnaire is only administered to survey participants aged 40 years and over. Grade 1 angina is defined based on a positive response to ever having had pain or discomfort in chest and ever getting pain or discomfort in chest when walking up hill or in a hurry (but not getting pain or discomfort in chest when walking at an ordinary pace on level ground) and stopping or slowing down if get it while walking and pain or discomfort relieved when standing still, and pain relieved in 10 minutes or less, plus either pain or discomfort located in upper sternum or lower sternum, or left chest and left arm. Grade 2 angina is defined based on positive responses to ever having had pain or discomfort in chest, ever getting pain or discomfort in chest when walking up hill or in a hurry, getting pain or discomfort in chest when walking at an ordinary pace on level ground, stopping or slowing down if get it while walking, pain or discomfort relieved when standing still, and pain relieved in 10 minutes or less, plus either pain or discomfort located in upper sternum or lower sternum, or left chest and left arm.
  2. Fasting LDL-c ≥190 mg/dL, no clinical ASCVD (as defined above): High-intensity statin therapy recommended.
  3. Aged 40-75 years with diabetes, no clinical ASCVD, and LDL-c 70-189 mg/dL: Moderate-intensity statin therapy recommended for those with a 10-yr risk for ASCVD <7.5%; High-intensity statin therapy recommended for those with a 10-year risk for ASCVD ≥7.5%. Diabetes includes diagnosed and undiagnosed. Diagnosed diabetes is defined for those who other than during pregnancy were told by a doctor or health professional that they had diabetes or sugar diabetes; taking insulin or taking diabetic pills to lower your blood sugar; Undiagnosed diabetes is defined as a fasting plasma glucose ≥126 mg/dL or an HbA1c ≥6.5%.
  4. Aged 40-75 years without clinical ASCVD or diabetes with LDL-c 70-189 mg/dL, and estimated ASCVD risk ≥7.5%: Moderate- to High-intensity statin therapy recommended.

ASCVD risk score is calculated based on the equations published by ACC/AHA. (Goff DC Jr, Lloyd-Jones DM, Bennett G, Coady S, D'Agostino RB Sr, Gibbons R, Greenland P, Lackland DT, Levy D, O'Donnell CJ, Robinson J, Schwartz JS, Smith SC Jr, Sorlie P, Shero ST, Stone NJ, Wilson PW. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;129 [suppl 2]:S1-S45.))

Cholesterol treatment defined as self report of following health professional's advice to take prescribed medicine to lower cholesterol or statin use identified in the prescription medication file.

Age-adjustment notes

This Indicator uses Age-Adjustment Groups:

  • Total: 21-49, 50-59, 60-69, 70-79, 80+
  • Sex: 21-49, 50-59, 60-69, 70-79, 80+
  • Race/Ethnicity: 21-49, 50-59, 60-69, 70-79, 80+
  • Educational Attainment: 25-49, 50-59, 60-69, 70-79, 80+
  • Family Income (percent poverty threshold): 21-49, 50-59, 60-69, 70-79, 80+
  • Health Insurance Status: 21-49, 50-59, 60-64
  • Marital Status: 21-49, 50-59, 60-69, 70-79, 80+
  • Country of Birth: 21-49, 50-59, 60-69, 70-79, 80+
  • Veteran Status: 21-49, 50-59, 60-69, 70-79, 80+
  • Activity Limitations: 21-49, 50-59, 60-69, 70-79, 80+
  • Obesity Status: 21-49, 50-59, 60-69, 70-79, 80+
  • Diabetes Status: 21-49, 50-59, 60-69, 70-79, 80+

History

Revision History
Revised. 

The baseline was revised from 44.9% to 45.0% due to a change in the definition of diabetes (dropped medication variable) and correcting the survey weight from the exam weight to fasting subsample weight. Coding corrections were also made to the activity limitations data line and age adjustment for education and health insurance. The target was revised from 54.9% to 55.0% using the original target setting method.


1. Effect size h=0.2 was chosen to correspond with 20% improvement from a baseline of 50%.