Background: As opposed to the prior cholesterol guideline which did not include low-density lipoprotein cholesterol (LDL-C) goal for secondary prevention, the 2018 American Heart Association (AHA)/American College of Cardiology (ACC) guideline recommends to lower LDL-C levels below 70 mg/dL in patients with atherosclerotic cardiovascular disease (ASCVD) who are at very high-risk. In this cross-sectional study, we investigated an epidemiological impact of the 2018 guideline with the new LDL-C goal for secondary prevention in the U.S. Methods: From the National Health and Nutrition Examination Survey (NHANES) 2005-2014, we identified very high-risk patients with clinical ASCVD who had completed a fasting blood test including LDL-C. ASCVD included self-reported coronary heart disease, angina, myocardial infarction, and any stroke. As per the guideline, very high-risk was defined as presence of multiple (≥ 2) high-risk conditions, such as old age (≥ 65 years), diabetes, hypertension, chronic kidney disease, current smoking, and history of heart failure. We estimated patients who were taking prescribed cholesterol medications and whose LDL-C level was ≥ 70 mg/dL despite the lipid-lowering therapy. Sampling weights were used in all statistical analyses to account for complex sampling design and nonresponse of the NHANES. Data are presented as weighted prevalence (%) and 95 % confidence interval (CI) or mean ± standard deviation. Results: Among 1093 nationally representative patients with clinical ASCVD, we finally included 978 patients who were at very-high risk (86.3 % [95 % CI, 83.1-88.9]). Their mean LDL-C level was 100.3 ± 2.8 mg/dL, and 77.5 % (95 % CI, 74.0-80.6) had LDL-C levels ≥ 70 mg/dL. Among patients who answered the survey question regarding lipid-lowering therapy (n =574), 91.3 % (95 % CI, 88.3-93.6) were taking prescribed cholesterol medications. Mean LDL-C level of those who were taking the cholesterol medications was 98.2 ± 14.0 mg/dL, and 68.9 % (95 % CI, 64.0-73.5) of them had LDL-C levels ≥ 70 mg/dL despite the lipid-lowering therapy. When this result was extrapolated to the entire U.S. population using the sampling weights, 6.1 million ASCVD patients at very high-risk who were on lipid-lowering therapy had LDL-C levels above the goal. Although we used data from 2005 to 2014 to include more patients, results were not so much different when the analyses were restricted to the most recent survey cycle (2013-2014). Conclusion: In the U.S., more than eight out of ten patients with clinical ASCVD were at very high-risk. Although majority of those very high-risk patients with ASCVD were receiving lipid-lowering therapy, about two thirds of them still had LDL-C levels above the goal recommended by the new cholesterol guideline. Therefore, more attention should be made for secondary prevention after ASCVD in very high-risk patients.
This study investigated the association between sleep duration, fat mass, lean mass and obesity. Participants of this cross-sectional study were 16 905 adults included into the 4th and 5th Korea National Health and Nutrition Examination Surveys. Sleep duration was assessed by self-reported survey and categorized into ≤ 5, 6, 7, 8 and ≥ 9 h per day. The group reporting 7 h of sleep per day (comprised of those sleeping 7-8 h per day) was used as the reference group. Body composition was measured by dual X-ray absorptiometry (DEXA). Obesity was defined based on the criteria from the Korean Society for the Study of Obesity. Least-squares means of fat mass index (FMI) and lean mass index (LMI) adjusted for age, employment status, comorbidities and physical activity were used to assess the relation between sleep duration and body composition. Multivariable logistic regression was used to calculate the adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) of obesity according to sleep duration after adjusting for sociodemographic and health-related factors. After adjustment, FMI increased with fewer hours of sleep (P for trend: < 0.001) and LMI decreased with more hours of sleep (P for trend: 0.011). Compared to the reference group, sleep-deprived individuals were 1.22 times more likely to have general obesity (aOR: 1.22; 95% CI: 1.03-1.45) and 1.32 times more likely to have abdominal obesity (aOR: 1.32; 95% CI: 1.10-1.58). Our findings suggest that sleep deprivation might be related to an increase of fat mass and obesity, while oversleeping could be linked to a reduction of lean mass.
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