Despite available medications for dyslipidemia, many treated patients still have suboptimal lipid levels. The aim of this study was to examine the extent of residual dyslipidemia in United States adults. Of 2509 United States adults aged ≥18 years from the National Health and Nutrition Examination Survey (NHANES) 2009-2010, 1,129 (41.8% weighted) had hyperlipidemia on the basis of modified treatment guidelines for low-density lipoprotein (LDL) cholesterol according to risk category or pharmacologic treatment. Of these, 484 (42.4%) were treated with lipid-modifying therapy, and the proportions of subjects who still had LDL cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, or non-HDL cholesterol not at recommended levels were examined. In this cohort treated for hyperlipidemia, the mean age was 60.1 ± 14.9 years, and 52% were men. Only 36.5% of subjects receiving treatment for hyperlipidemia were at goal or normal levels for all 3 lipids (LDL cholesterol, HDL cholesterol, and triglycerides). LDL cholesterol remained higher than goal for 37.5% of subjects, 28.9% had low HDL cholesterol, and 36.3% had elevated triglycerides. One, 2, and 3 lipid parameters were at abnormal levels in 32.4%, 23.0%, and 8.2% of subjects, respectively; 36.5% had no lipid disorder. In addition, 38.6% of treated subjects were above non-HDL cholesterol goal, and even in those at LDL cholesterol goal, 12.9% were not at non-HDL cholesterol goal. Those with cardiovascular disease conditions had poorer goal attainment of LDL cholesterol, HDL cholesterol, and composite all lipids than those without cardiovascular disease. In conclusion, despite widely available treatments for dyslipidemia, many patients remain at suboptimal lipid levels, indicating need for greater adherence to lifestyle and medical therapies to address these gaps in the management of dyslipidemia.
Despite widespread publicity of the National Cholesterol Education Program guidelines, recently published United States data indicate that despite significant improvements in low-density lipoprotein (LDL) cholesterol levels in the population, many subjects still have suboptimal levels of LDL cholesterol, and hypertriglyceridemia has actually increased in recent years. We and others have reported that only 1/3 of those with cardiovascular disease (CVD) or diabetes have optimal LDL cholesterol levels, and very few are at recommended levels for all lipids (LDL cholesterol, high-density lipoprotein [HDL] cholesterol, and triglycerides). National treatment recommendations focus on management of LDL cholesterol as the primary target of therapy, so statin medications have played a central role in the management of dyslipidemia. Although statin use has contributed to observed improvements in population LDL cholesterol levels, residual risk remains, often due to low HDL cholesterol and/or elevated triglycerides. No recent population-based data are available on the extent of recommended lipid level achievement and residual dyslipidemia in those treated for hyperlipidemia. In a large United States population–representative sample of adults surveyed in 2009 and 2010, we examined the distribution of lipid levels (LDL cholesterol, HDL cholesterol, triglycerides, and non-HDL) in patients with hyperlipidemia, specifically those treated with lipid-modifying therapy.
Methods
We used the National Health and Nutrition Examination Survey (NHANES) 2009-2010 to assess United States adults aged ≥18 years who had complete lipid and other risk factor information. Conducted by the Centers for Disease Control and Prevention, NHANES is a cross-sectional survey with demographic information, medical history, and medical examination data among a population-based sample of noninstitutionalized adults.
We defined subjects with hyperlipidemia as those with elevated LDL cholesterol or evidence of treatment from subjects’ medication bottles brought into the examination visit (any prescription for statins, bile acid sequestrants, fibric acid derivatives, cholesterol absorption inhibitors, niacin, or omega-3 polyunsaturated fatty acids as previously described ). For the purposes of risk stratification to determine target LDL cholesterol levels, the updated Framingham risk score for 10-year risk for total CVD using total and HDL cholesterol, diabetes status, systolic blood pressure, and/or antihypertensive use and cigarette smoking was applied. This captures all CVD (including coronary heart disease [CHD], stroke, and heart failure) rather than the more limited risk scores used by the Third Adult Treatment Panel of the National Cholesterol Education Program, which estimate the risk for only hard CHD events.
Target levels for LDL cholesterol were adapted from the National Cholesterol Education Program but updated on the basis of more recent recommendations for an optional LDL cholesterol goal of <70 mg/dl for those with preexisting CHD. Analyses were also conducted using a target of <100 mg/dl for these participants (being a class Ia as opposed to a class IIa recommendation for <70 mg/dl). For other subjects, LDL cholesterol goal was set at <100 mg/dl if other CVD, >20% 10-year risk for total CVD, diabetes mellitus, and/or chronic kidney disease was present; <130 mg/dl if ≥2 risk factors were present or Framingham 10-year risk was 10% to 20%; and <160 mg/dl if <2 risk factors were present and Framingham risk was <10%. Recommended non-HDL cholesterol cut points were 30 mg/dl higher than LDL cholesterol goals. Other lipids were designated as normal if HDL cholesterol ≥40 mg/dl if male and ≥50 mg/dl if female and triglycerides <150 mg/dl. Risk factors for the purposes of setting LDL cholesterol and non-HDL cholesterol goals were age (≥45 years for men, ≥55 years for women), low HDL cholesterol (<40 mg/dl for men, <50 mg/dl for women), cigarette smoking, hypertension (systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg [≥130/80 mm Hg if diabetes] or use of antihypertensive medication), or a positive family history of CHD.
Subjects were also categorized according to the presence of metabolic syndrome, diabetes, chronic kidney disease, and CVD (including CHD, heart failure, or stroke). Metabolic syndrome was defined according to the presence of ≥3 of the following: waist circumference >102 cm if male or >88 cm if female, HDL cholesterol <40 mg/dl if male or <50 mg/dl if female, triglycerides ≥150 mg/dl, blood pressure ≥130 mm Hg systolic or ≥85 mm Hg diastolic or use of antihypertensive therapy, or fasting glucose of 100 to 125 mg/dl. Diabetes was identified according to physician report, use of antihyperglycemic medication, or fasting glucose ≥126 mg/dl. Chronic kidney disease was defined as having an estimated glomerular filtration rate <60 ml/min. This was calculated using the Modification of Diet in Renal Disease (MDRD) study equation: estimated glomerular filtration rate = 186 × (serum creatinine) −1.154 × age −0.203 × 0.742 (if female) × 1.210 (if black). CVD was identified by self-report on the study questionnaire.
Total cholesterol and triglycerides were measured enzymatically by manipulating serum or plasma samples with a series of coupled reactions that yielded hydrogen peroxide as a byproduct. The absorbance of this substance corresponded to the total cholesterol or triglyceride concentration. HDL cholesterol was measured directly in the serum, and LDL cholesterol was calculated using the Friedewald formula. Non-HDL cholesterol was calculated by subtracting HDL cholesterol from total cholesterol. Blood pressure was measured using a mercury sphygmomanometer, which takes the average of up to 4 readings. Detailed specimen and data collection are discussed in the Laboratory/Medical Technologists Procedures Manual.
Using the overall study sample, we estimated proportions and numbers (projected in millions) of United States adults with 1, 2, or 3 lipid abnormalities (LDL cholesterol, HDL cholesterol, and/or triglycerides). For subjects with hyperlipidemia, descriptive statistics were used to assess mean lipid levels and proportions at therapeutic goal or normal levels for LDL cholesterol, HDL cholesterol, triglycerides, and non-HDL cholesterol individually and for the composite “all lipids” (LDL cholesterol, HDL cholesterol, and triglycerides). We further stratified these measures by demographic characteristics, global risk group (on the basis of Framingham risk score), co-morbid disease, and treatment with any lipid-modifying therapy. For subjects who were treated, similar analyses were conducted, and we also ascertained the proportion of subjects receiving statin monotherapy, statin combination therapy, or other lipid-modifying therapy. Chi-square tests were used to compare proportions, and Student’s t tests or analysis of variance was used to compare means across gender, age, ethnicity, global risk, and disease groups, with Fisher’s exact tests used for analyses for which small sample sizes were present. SUDAAN version 9.0.1 (Research Triangle Institute, Research Triangle Park, North Carolina) was used to project results to United States population estimates using sample weighting, with statistical procedures done with SAS version 9.1.3 (SAS Institute Inc., Cary, North Carolina). Percentages reported represent sample-weighted proportions.
Results
Of 5,995 United States adults aged ≥18 years (representing 223 million) surveyed, 2,509 (90.3 million) had complete information on medical history, nonlipid risk factors, and lipid values. On the basis of this analytic cohort, 41.8% (n = 1,129 [37.7 million]) were identified with hyperlipidemia (treated or untreated). Only 26.5% were at LDL cholesterol goal, 32.6% were at non-HDL cholesterol goal, and 66.4% and 63.6% were at normal levels of HDL cholesterol and triglycerides, respectively ( Table 1 ). Among those at LDL cholesterol goal, 10.9% had not achieved their non-HDL cholesterol goal. Recommended levels of composite all lipids were observed in only 15.5% of participants.
| Variable | n (N ⋮ ) | LDL Cholesterol (mg/dl) | HDL Cholesterol (mg/dl) | Triglycerides (mg/dl) | Non-HDL Cholesterol (mg/dl) | All Lipids ¶ | ||||
|---|---|---|---|---|---|---|---|---|---|---|
| Mean ± SD | At Goal | Mean ± SD | Normal | Mean ± SD | Normal | Mean ± SD | At Goal | At Goal | ||
| Overall | 1,129 (37.7) | 131.2 ± 40.1 | 26.5% | 51.7 ± 14.8 | 66.4% | 139.6 ± 64.9 | 63.6% | 159.2 ± 43.7 | 32.6% | 15.5% |
| Men | 589 (19.6) | 127.7 ± 40.0 † | 27.2% | 48.1 ± 13.1 ∗ | 73.2% † | 131.9 ± 64.7 [CR] | 69.9% † | 154.1 ± 43.5 ∗ | 35.5% | 17.6% |
| Women | 540 (18.2) | 135.1 ± 40.0 | 25.7% | 55.6 ± 15.4 | 58.9% | 147.9 ± 64.8 | 56.8% | 164.7 ± 43.5 | 29.6 % | 13.1% |
| Age 18–65 yrs | 641 (24.7) | 139.3 ± 38.4 ∗ | 22.8% ∗ | 49.8 ± 13.9 ∗ | 62.2% | 143.7 ± 67.2 † | 61.3 | 168.0 ± 41.2 ∗ | 29.5% ‡ | 12.1% † |
| Age >65 yrs | 488 (13.0) | 115.9 ± 37.1 | 33.6% | 55.4 ± 15.4 | 74.2% | 131.9 ± 60.8 | 68.0% | 142.3 ± 40.9 | 38.7% | 31.8% |
| White | 609 (28.3) | 129.7 ± 40.0 | 29.5% † | 52.2 ± 15.5 ‡ | 66.4% | 140.3 ± 64.9 ∗ | 63.9% ∗ | 157.7 ± 44.3 | 34.0% ‡ | 17.0% ‡ |
| Hispanic | 290 (4.0) | 137.4 ± 40.4 | 19.9% | 49.5 ± 13.7 | 67.2% | 160.9 ± 66.9 | 50.1% | 169.6 ± 43.7 | 26.9% | 10.6% |
| Black | 179 (3.6) | 137.2 ± 38.1 | 13.2% | 52.9 ± 14.3 | 65.9% | 116.7 ± 54.6 | 75.6% | 160.6 ± 40.8 | 25.9% | 10.1% ∗∗ |
| Global risk | ||||||||||
| Low (<10%) | 310 (12.4) | 141.1 ± 40.6 ∗ | 30.8% | 53.8 ± 14.5 ∗ | 68.5% | 130.4 ± 59.6 † | 67.7% † | 167.2 ± 44.6 ∗ | 41.2% † | 20.9% ‡ |
| Intermediate (10%–20%) | 281 (10.3) | 138.6 ± 39.9 | 26.9% | 52.6 ± 15.0 | 69.3% | 147.2 ± 65.4 | 60.9% | 168.0 ± 43.0 | 28.7% | 15.2% |
| High (>20%) | 313 (8.0) | 126.2 ± 34.4 | 21.7% | 48.7 ± 14.2 | 64.5% | 149.6 ± 67.8 | 58.7% | 156.1 ± 37.6 | 24.0% | 11.2% ∗∗ |
| CVD | 225 (8.0) | 103.5 ± 34.4 | 22.7% | 49.3 ± 15.3 | 59.1% | 133.9 ± 66.7 | 65.6% | 130.2 ± 39.8 | 31.9% | 9.7% |
| Disease group | ||||||||||
| No disease | 236 (9.6) | 149.2 ± 37.5 | 24.0% | 55.3 ± 15.3 | 82.4% | 120.3 ± 48.2 | 79.0% | 173.3 ± 40.4 | 35.9% | 20.4% |
| CVD | 225 (6.0) | 103.5 ± 34.4 ∗ | 22.7% | 49.3 ± 15.3 † | 59.1% † | 133.9 ± 68.0 ‡ | 65.6% † | 130.2 ± 39.8 ∗ | 31.9% | 9.7% † |
| CHD | 161 (4.4) | 99.9 ± 32.8 ∗ | 16.7% | 49.4 ± 16.1 † | 58.0% ‡ | 134.0 ± 69.0 † | 65.7 ‡ | 126.7 ± 38.6 ∗ | 30.0 | 5.8 †,∗∗ |
| Heart failure | 62 (1.6) | 103.1 ± 29.4 ∗,∗∗ | 28.5% ∗∗ | 51.6 ± 19.5 | 59.0% † | 138.1 ± 69.4 ‡ | 60.4 ‡ | 130.7 ± 35.4 ∗,∗∗ | 28.8 ∗∗ | 13.7 ∗∗ |
| Stroke | 71 (18.7) | 115.9 ± 39.6 ∗,∗∗ | 21.9% ∗∗ | 48.8 ± 14.7 † | 44.2% † | 127.4 ± 67.7 | 72.1 | 141.4 ± 43.7 ∗ | 29.2 | 9.4 ‡ |
| Diabetes | 291 (7.9) | 106.8 ± 34.2 ∗ | 38.6% † | 48.9 ± 12.4 ∗ | 61.4% ∗ | 144.6 ± 72.9 ∗ | 58.5 ∗ | 135.8 ± 39.4 ∗ | 38.5 | 17.8 |
| Metabolic syndrome | 499 (16.3) | 128.2 ± 38.3 ∗ | 25.6% | 45.8 ± 12.8 ∗ | 39.6% ∗ | 172.3 ± 71.5 ∗ | 37.9 ∗ | 162.7 ± 42.9 ∗ | 24.3 ‡ | 5.8 ∗∗ |
| Chronic kidney disease | 171 (5.1) | 116.7 ± 36.8 ∗ | 27.7% | 53.6 ± 14.8 | 64.7% ‡ | 136.1 ± 60.4 † | 69.2 | 144.0 ± 40.2 ∗ | 31.0 | 14.7 ∗∗ |
| Treatment group | ||||||||||
| Treatment | 484 (16.0) | 100.3 ± 31.7 ∗ | 62.5% ∗ | 52.2 ± 14.4 | 71.1% | 136.2 ± 67.8 | 63.7 | 127.6 ± 36.3 ∗ | 61.4 ∗ | 36.5 ∗ |
| No treatment | 645 (21.7) | 154.0 ± 31.2 | — | 51.4 ± 15.0 | 62.9% | 142.1 ± 62.7 | 63.6 | 182.4 ± 34.9 | 11.5 | 0 |
∗ p <0.001, † p <0.01, and ‡ p <0.05, comparison across strata for gender, age, ethnicity, global risk, and treatment groups (disease groups compared with no disease).
§ Means and proportions represent sample-weighted values.
⋮ Weighted sample size in millions.
¶ LDL cholesterol, HDL cholesterol, and triglycerides.
∗∗ Represents sample size <30, suggesting that the estimate may be unreliable.
Across disease groups, patients with diabetes were more likely to be at LDL cholesterol and non-HDL cholesterol goals, and those with CVD were less likely compared with those with other co-morbid conditions ( Figure 1 ). Among those with CHD, only 16.7% were at LDL cholesterol <70 mg/dl (57.1% for LDL cholesterol <100 mg/dl), with 30.0% and 56.8%, respectively, at non-HDL cholesterol goals; 5.8% (29.6% if based on LDL cholesterol <100 mg/dl) were at recommended levels for all lipids. However, the American Heart Association and American College of Cardiology Foundation secondary prevention performance criterion of achieving LDL cholesterol <100 mg/dl or having a prescribed plan (e.g., statin) for treatment in those with CHD was met in 81.4% of patients with CHD (not shown).
In patients with hyperlipidemia, 42.4% (n = 484 [15.9 million]) were receiving pharmacologic treatment, with most receiving statin monotherapy (82.4%), followed by other lipid-modifying medications alone (9.5%) and statins in combination with other agents (8.1%) ( Table 2 ). Treatment rates were significantly higher in those with previous CVD, diabetes, metabolic syndrome, and chronic kidney disease compared with subjects with no co-morbid disease. For those with CHD, 65% were receiving lipid-modifying therapy.
| Variable | Sample n (N ⋮ ) | On Treatment | Statins Alone | Other Lipid-Modifying Therapy # | Statin Therapy in Combination # |
|---|---|---|---|---|---|
| Overall | 1,129 (37.7) | 42.4% | 82.4% | 9.5% | 8.1% |
| Men | 589 (19.6) | 43.7% | 86.7% | 7.4% ∗∗ | 5.9% |
| Women | 540 (18.2) | 40.9% | 77.5% | 11.9% | 10.6% |
| White | 609 (28.3) | 45.4% † | 82.8% | 8.7% ∗∗ | 8.5% |
| Hispanic | 290 (4.0) | 33.6% | 79.0% | 14.4% ∗∗ | 6.7% ∗∗ |
| Black | 179 (3.6) | 31.3% | 83.8% | 9.2% ∗∗ | 7.0% ∗∗ |
| Global risk group | |||||
| Low (<10%) | 310 (12.4) | 37.2% ∗ | 81.9% | 13.6% ∗∗ | 4.5% ∗∗ |
| Intermediate (10%–20%) | 281 (10.3) | 34.6% | 80.6% | 8.2% ∗∗ | 11.3% ∗∗ |
| High (>20%) | 313 (8.0) | 43.8% | 83.8% | 9.2% ∗∗ | 7.0% ∗∗ |
| CVD | 225 (8.0) | 65.3% | 83.5% | 5.7% ∗∗ | 10.8% |
| Disease group | |||||
| No disease | 236 (9.6) | 28.3% | 88.6% | 6.5% ∗∗ | 4.9% ∗∗ |
| CVD | 225 (6.0) | 65.3% ∗ | 83.5% | 5.7% ∗∗ | 10.8% |
| CHD | 161 (4.4) | 64.8% ∗ | 80.7% | 6.2% ∗∗ | 13.2% |
| Heart failure | 62 (1.6) | 68.5% † | 92.9% ∗ | 2.9% ∗∗ | 4.3% |
| Stroke | 71 (18.7) | 52.4% | 81.2 | 4.6% ∗∗ | 14.2% ∗∗ |
| Diabetes | 291 (7.9) | 62.1% ∗ | 84.4 | 8.0% ∗∗ | 7.6% |
| Metabolic syndrome | 499 (16.3) | 44.1% | 82.8 | 6.4% | 10.9% |
| Chronic kidney disease | 171 (5.1) | 52.8% ‡ | 77.6 | 12.4% ∗∗ | 10.0% ∗∗ |
∗ p <0.001, † p <0.01, and ‡ p <0.05, comparison across strata for gender, age, ethnicity, global risk, and treatment groups (disease groups compared with no disease).
§ Means and proportions represent sample-weighted values.
⋮ Weighted sample size in millions.
# Statistical comparisons not conducted, because of small sample sizes.
∗∗ Represents sample size <30, suggesting that the estimate may be unreliable.
In patients treated with lipid-modifying therapy, goal attainment was observed in 62.5% of patients for LDL cholesterol and 61.4% for non-HDL cholesterol, and 71.1% and 63.7% of patients were at normal HDL cholesterol and triglyceride levels, respectively ( Table 3 ). However, only 36.5% of treated subjects were at optimal levels of composite all lipids, and 32%, 23%, and 8% of patients had 1, 2, and 3 lipid abnormalities, respectively ( Figure 2 ).
| Variable | n (N ⋮ ) | LDL Cholesterol (mg/dl) | HDL Cholesterol (mg/dl) | Triglycerides (mg/dl) | Non-HDL Cholesterol (mg/dl) | All Lipids ¶ | ||||
|---|---|---|---|---|---|---|---|---|---|---|
| Mean ± SD | At Goal | Mean ± SD | Normal | Mean ± SD | Normal | Mean ± SD | At Goal | At Goal | ||
| Overall | 484 (15.9) | 100.3 ± 31.7 | 62.5% | 52.2 ± 14.4 | 71.1% | 136.2 ± 67.8 | 63.7% | 127.6 ± 36.3 | 61.4% | 36.5% |
| Men | 251 (8.6) | 96.8 ± 31.0 † | 62.2% ‡ | 48.2 ± 12.3 ∗ | 76.9% ‡ | 129.5 ± 67.9 ‡ | 68.4% | 122.7 ± 34.9 | 65.5% ‡ | 40.3% |
| Women | 233 (7.4) | 104.5 ± 31.8 | 62.8% | 56.7 ± 15.0 | 64.4% | 144.1 ± 67.1 | 58.2% | 133.3 ± 36.9 | 56.7% | 32.1% |
| Age 18–65 yrs | 201 (8.5) | 104.9 ± 32.9 † | 65.9% | 49.8 ± 13.4 ∗ | 68.5% | 143.5 ± 75.7 ‡ | 58.3% | 133.6 ± 37.0 ∗ | 61.4% | 35.2% |
| Age >65 yrs | 283 (7.5) | 95.1 ± 29.2 | 58.5% | 54.9 ± 14.9 | 74.1% | 128.0 ± 60.4 | 69.8% | 120.7 ± 33.7 | 61.5% | 38.0% |
| White | 280 (12.8) | 99.7 ± 31.5 | 64.9% ‡ | 52.2 ± 14.7 † | 69.8% | 135.1 ± 66.0 † | 63.9% † | 126.7 ± 36.8 | 63.2% | 37.5% |
| Hispanic | 117 (1.3) | 99.5 ± 30.0 | 59.1% | 50.9 ± 15.2 | 67.7% | 164.8 ± 74.7 | 49.7% | 132.5 ± 36.2 | 55.5% | 31.5% |
| Black | 64 (1.1) | 108.7 ± 32.9 | 42.3% | 54.6 ± 13.3 | 81.1% | 112.7 ± 54.9 | 82.0% | 131.3 ± 34.6 | 51.0% | 32.4% ∗∗ |
| Global risk | ||||||||||
| Low (<10%) | 104 (5.0) | 102.7 ± 32.6 | 82.6% ∗ | 57.2 ± 14.2 ∗ | 81.7% ‡ | 118.6 ± 61.6 ∗ | 74.3% | 126.4 ± 36.6 | 78.8 ∗ | 56.0% ∗ |
| Intermediate (10%–20%) | 102 (3.6) | 102.7 ± 34.9 | 77.6% | 53.3 ± 14.1 | 72.3% | 137.4 ± 64.7 | 61.7% | 130.3 ± 37.6 | 72.4% | 43.8% |
| High (>20%) | 129 (3.5) | 102.2 ± 27.1 | 49.5% | 48.3 ± 14.3 | 66.2% | 157.3 ± 71.6 | 53.3% | 133.7 ± 31.0 | 46.7% | 25.5% ∗∗ |
| CVD | 149 (3.9) | 93.5 ± 31.4 | 34.7% | 48.1 ± 13.4 | 60.9% | 138.9 ± 68.7 | 61.1% | 121.3 ± 38.7 | 42.5% | 14.8% |
| Disease group | ||||||||||
| No disease | 57 (2.7) | 106.0 ± 36.6 | 85.1% | 59.1 ± 14.1 | 96.1% | 103.4 ± 40.0 | 87.6% | 126.8 ± 38.5 | 86.6% | 72.2% |
| CVD | 149 3.9) | 93.5 ± 31.4 † | 34.7% ∗ | 48.1 ± 13.4 ∗ | 60.9% ∗ | 138.9 ± 68.7 † | 61.1% † | 121.3 ± 38.7 | 42.5% ∗ | 14.8% ∗ |
| CHD | 105 2.9) | 91.9 ± 32.8 † | 25.8% ∗ | 48.1 ± 14.2 ∗ | 58.7% ∗ | 142.3 ± 72.5 ∗ | 59.9% † | 120.4 ± 41.4 | 39.2% ∗ | 9.0% ∗ |
| Heart failure | 44 (1.0) | 98.2 ± 28.4 ‡ | 41.6% † | 46.5 ± 13.3 ∗ | 50.7% † | 141.5 ± 66.7 † | 57.6% ‡,∗∗ | 126.5 ± 36.8 ∗∗ | 37.1% ‡ | 20.1% ∗ |
| Stroke | 43 (1.0) | 97.6 ± 32.5 † | 41.7% † | 48.1 ± 11.9 ∗ | 54.6% † | 131.3 ± 64.6 † | 68.5% ‡ | 123.9 ± 36.7 ∗∗ | 41.4% ‡ | 18.0% ∗ |
| Diabetes | 183 (4.9) | 92.4 ± 29.0 † | 62.1% † | 48.1 ± 12.8 ∗ | 62.0% ∗ | 152.0 ± 75.1 ∗ | 55.0% ∗ | 122.8 ± 35.7 | 54.2% | 29.0% ∗ |
| Metabolic syndrome | 227 (7.2) | 101.0 ± 30.0 ‡ | 57.9% † | 45.7 ± 12.9 ∗ | 43.6% ∗ | 172.2 ± 74.8 ∗ | 36.3% ∗ | 135.5 ± 36.4 | 47.4% ∗ | 13.1% ∗ |
| Chronic kidney disease | 94 (2.7) | 93.8 ± 29.0 † | 52.4% ∗ | 53.0 ± 13.7 † | 65.2% ∗ | 136.6 ± 56.7 † | 66.2% † | 121.1 ± 33.7 | 52.1% | 27.8% ∗ |
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