Cardiovascular Disease Burden and Clinical Associations Among US Adults Using Survey-Weighted Data Analytics
Year: 2024
Type: article
Study design: Observational Study
Abstract: A standard lipid panel provides several related measures of cardiovascular health, but their interpretation depends on disease history, treatment, and the equation used to estimate low-density lipoprotein cholesterol. Analyses that overlook these features can confuse the consequences of established disease with the factors that preceded it. To examine the joint associations of LDL cholesterol, high-density lipoprotein cholesterol, and triglycerides with reported cardiovascular disease and quantify disagreement among three LDL estimation methods in the same survey participants. We analyzed 2,225 adults aged 20 years or older from the National Health and Nutrition Examination Survey 2017–2018. Participants had positive fasting subsample weights, complete lipid measurements, triglycerides below 400 mg/dL, classifiable disease history, and complete model covariates. Cardiovascular disease was defined as reported coronary heart disease, myocardial infarction, or stroke. Survey weighted logistic models included LDL, HDL, and log2 triglycerides together, with clinical covariates and a separate adjustment for reported cholesterol medication use. LDL categories were compared using Friedewald, Martin–Hopkins, and Sampson estimates. Confidence intervals incorporated survey strata and primary sampling units. There were 234 participants with cardiovascular disease history. Weighted prevalence was 8.34% with a 95% confidence interval of 6.37%–10.86%. Mean LDL was lower among participants with disease history, whereas cholesterol medication use was substantially higher. The LDL prevalence odds ratio per 30 mg/dL was 0.76 (0.61–0.94) before medication adjustment and 0.85 (0.69–1.06) afterward. Medication adjusted estimates were 1.05 (0.84–1.31) per 10 mg/dL HDL and 1.34 (0.87–2.04) per triglyceride doubling. Relative to Friedewald, LDL category disagreement was 9.12% for Martin– Hopkins and 7.02% for Sampson. At triglycerides of 200–399 mg/dL, disagreement reached 38.21% and 23.64%, respectively. Treatment context materially changed the interpretation of LDL associations, while triglyceride concentration identified where LDL category disagreement was concentrated. These findings support careful integration of lipid measurement and disease history in cardiovascular analytics. They do not establish causation, future event prediction, or the accuracy of one equation against a reference assay.
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7221702374