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Trends in Apolipoprotein B, Non-High-Density Lipoprotein, and Low-Density Lipoprotein for Adults 60 Years and Older by Use of Lipid-Lowering Medications: United States, 2005 to 2006 Through 2013 to 2014.

Over the years, guidelines for cholesterol lowering have focused on total cholesterol (TC) or low-density lipoprotein cholesterol (LDL-C). However, in recent years, apolipoprotein B (apo B) and non–high-density lipoprotein cholesterol (HDL-C) have been proposed as better measures of the atherosclerotic burden of lipids and improved measures for risk prediction.1 In this research letter, we examine trends in mean apo B, non–HDL-C, and LDL-C in adults ≥60 years of age by use of lipid-lowering medication from 2005 to 2006 through 2013 to 2014 using five 2-year cross-sectional NHANES (National Health and Nutrition Examination) surveys.

NHANES uses a stratified, multistage probability design to produce samples representative of the US noninstitutionalized population. Written informed consent was obtained from adult participants. The survey was approved by the National Center for Health Statistics Research Ethics Review Board.

NHANES includes a home interview consisting of health-related questions, including lipid-lowering medication use, and an examination at a mobile examination center that included blood-derived measures. Participants in the examination component were randomly assigned to a morning session (and asked to fast at least 9 hours before examination) or an afternoon/evening session. Each examined participant was eligible for TC and HDL-C; only participants examined in the morning were eligible for apo B and triglycerides.

In 2013 to 2014, 57.8% of adults ≥60 years of age eligible for the survey were examined. Comparable response rates for 2011 to 2012, 2009 to 2010, 2007 …