Amanda Marma Perak, MD, MSAssistant Professor of Pediatrics (Cardiology) and Preventive Medicine

Cholesterol Levels in American Youth Improving, But Only Half Have Ideal Lipid Levels Interview with:

Amanda Marma Perak, MD, MSAssistant Professor of Pediatrics (Cardiology) and Preventive Medicine

Dr. Marma Perak

Amanda Marma Perak, MD, MS
Assistant Professor of Pediatrics (Cardiology) and
Preventive Medicine What is the background for this study?

Response: Blood cholesterol is a critical initiator of atherosclerotic plaques in the arteries that can lead to heart attack in adulthood. It is well established that these changes in the blood vessels occur already in childhood. Thus, it is important to know the status of cholesterol levels in youth to inform public health efforts aimed at preventing cardiovascular disease in the population.

In the US there have been changes in childhood obesity prevalence (which may worsen cholesterol levels), the food supply (such as reduction of trans fats which may improve cholesterol levels), and other factors in recent years.

We therefore designed a study to examine trends in cholesterol levels among youth in recent years.

What are the main findings?

Response: We used data from over 26,000 youths aged 6 to 19 years in the nationally representative National Health and Nutrition Examination Surveys from 1999 to 2016 to examine recent trends in levels of total, high-density lipoprotein (HDL), non-HDL, and low-density lipoprotein (LDL) cholesterol, as well as triglycerides and apolipoprotein B.

We found favorable trends in the levels of all of these lipid and lipoprotein measures. Nevertheless, in the most recent years, only about half of US youth have all lipid levels in the clinically “ideal” range, and up to about 25% have at least 1 lipid level in the clinically “adverse” range. What should readers take away from your report?

Response: The improvements in lipid levels seen in youth from 1999 to 2016 are encouraging, since cholesterol is a key driver of cardiovascular disease. On the other hand, it is concerning that still only half of youth have all ideal lipid levels and up to 25% have at least one adverse lipid level. Clearly, we have more work to do on the underlying causes of cholesterol problems in childhood, such as poor diet, lack of exercise, and unhealthy weight. What recommendations do you have for future research as a result of this work?

Response: It is currently unknown why cholesterol levels have been improving in US youth in recent years. In particular, given ongoing increases in the prevalence of childhood obesity, the favorable cholesterol trends are somewhat unexpected. Further research should try to determine the underlying causes of these favorable trends, to help us understand which public health efforts have been successful and should continue, and which targets need new strategies to alter them in the future. Is there anything else you would like to add? 

Response: Dr. Marma Perak’s work was supported in part by a National Institutes of Health training grant (T32 HL069771), a National Heart, Lung and Blood Institute career development award (K23 HL145101), and a Pediatric Physician-Scientist Research Award from the Department of Pediatrics at Northwestern University Feinberg School of Medicine. Full disclosures for all authors can be found within the article. 


Perak AM, Ning H, Kit BK, et al. Trends in Levels of Lipids and Apolipoprotein B in US Youths Aged 6 to 19 Years, 1999-2016. JAMA. 2019;321(19):1895–1905. doi:10.1001/jama.2019.4984

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Last Updated on May 22, 2019 by Marie Benz MD FAAD