Dyslipidemia prevalence, treatment, control, and awareness in the Canadian health measures survey.
Joffres, Michel ; Shields, Margot ; Tremblay, Mark S. 等
High lipid levels are a major risk factor for cardiovascular
disease (CVD), which is a leading cause of death for Canadian men and
women. (1) It is estimated that dyslipidemia is responsible for about
4.4 million deaths worldwide. (2) Population surveillance is important
in monitoring risk factors for cardiovascular and other diseases.
However, there is a paucity of population-level data on lipid levels.
Estimates in the US indicate that 53% of adults have dyslipidemia. (3)
No recent comparable Canadian data have been published. Population-level
data on lipid levels in Canadians was last collected in the 1986-1992
Canadian Heart Health Surveys (CHHS), at which time 44% of respondents
had elevated total cholesterol levels above 5.2 mmol/L; 14% had LDL
cholesterol (LDL-C) levels above 4.1 mmol/L; and 8% had HDL cholesterol
(HDL-C) values below 0.9 mmol/L. (4)
The Canadian Health Measures Survey (CHMS) is the most
comprehensive population-representative direct measures survey ever
conducted in Canada and provides recent laboratory-measured data on
lipid levels of Canadians. The purpose of this paper was to determine
the proportion of the Canadian population with dyslipidemia, the number
aware of their lipid levels status and the number being treated for
their condition. The proportion of the Canadian population who adhered
with the 2009 Canadian Cardiovascular Society lipid targets (5) was also
assessed.
METHODS
Data source
The CHMS is a nationally representative survey of the household
population. (6-8) Data for cycle 1 were collected from March 2007
through February 2009 at 15 sites across the country for respondents
aged 6 to 79 years. Full-time members of the Canadian Forces and
residents of Crown lands, Indian reserves, institutions and certain
remote regions were excluded. The sample represented approximately 96%
of the population. (9)
The CHMS consisted of a household interview where information about
socio-demographic characteristics, health and lifestyle was gathered.
This was followed by a visit to a mobile examination centre, which
included physical measures and bio-specimen sampling (blood and urine).
(10)
Of the households selected for the survey, 69.6% agreed to
participate, 88.3% completed the household questionnaire, and 84.9%
participated in the subsequent examination component of the survey. The
final response rate, after adjusting for the sampling strategy, was
51.7%. (9)
Blood samples were collected as part of the mobile examination
centre component (see Bryan et al. (10) for details). Approximately half
of respondents were selected at random to fast before blood samples were
taken. This study is based on 1,701 respondents aged 20 to 79 years who
were part of the fasting subsample. The overall combined response rate
for the fasting subsample was 46.3%. Sampling weights were provided for
the fasting subsample which incorporated an adjustment for the
probability of being selected into the subsample, a nonresponse
adjustment (based on characteristics available for respondents vs.
non-respondents to this component of the survey) and calibration to
ensure that estimates based on these weights were representative of the
Canadian population by sex, age group and geographical region. (9)
Measures
Respondents were defined as having measured dyslipidemia if:
* measured total cholesterol (TC)/HDL-C ratio was [greater than or
equal to] 5; or
* measured LDL-C was >3.5 mmol/L.
In addition to the measured values, respondents who reported taking
lipid-modifying medication in the month before the mobile examination
component were also considered as having dyslipidemia. Respondents were
asked to provide the Drug Identification Numbers (DIN) for all
prescription medications they were taking. These were subsequently coded
using the Anatomical Therapeutic Chemical (ATC) classification system.
(11) Lipid-modifying medications were defined as all C10A
(lipid-modifying agents) and C10B (lipid-modifying agents, combinations)
drugs with the exception of C10AX01 (dextrothyroxine).
Respondents who were classified as having dyslipidemia (measured
high lipid levels or taking lipid-modifying medication) were defined as
being aware if, during the household interview, they reported that they
had been told by a health professional that their blood cholesterol was
high.
Guidelines for the Diagnosis and Treatment of Dyslipidemia Based on
the 2009 guidelines for the diagnosis and treatment of dyslipidemia, (5)
respondents were categorized as being at low, moderate or high risk of
CVD. These guidelines define risk according to the criteria in Table 1.
In the CHMS, not all of the information was available for the
criteria specified for the high-risk group. Therefore in this study high
risk was defined as a Framingham risk score [greater than or equal to]
20%, (12) Reynolds risk score [greater than or equal to] 20%, (13)
diabetes (in men >45 years or women >50 years), or self-reported
heart disease, heart attack or stroke. Diabetes was defined as elevated
fasting glucose of [greater than or equal to] 7 mmol/L or the use of
insulin in the previous month.
Based on risk level, the guidelines specify criteria for which
treatment initiation is recommended. CHMS respondents were categorized
based on the criteria in Table 1. Primary targets are also specified by
risk level (Table 1).
With CHMS data, it was not possible to assess a reduction in LDL-C,
but respondents were categorized as treated and achieving target levels
based on the other target criteria outlined in Table 1. Individuals
treated but not reaching the treatment targets in each risk category
were defined as not achieving target levels.
All estimates were based on weighted data using the sampling
weights provided for the fasting subsample. Statistical analyses were
performed using SAS and SUDAAN software. Standard errors, coefficients
of variation and 95% confidence intervals were calculated with the
bootstrap technique. (14,15) The number of degrees of freedom was
specified as 11 to account for the CHMS sample design. (9) Significance
levels were set at p<0.05.
RESULTS
Using a simple definition of dyslipidemia, based on LDL-C levels of
[greater than or equal to] 3.5 mmol/L or TC/HDL-C [greater than or equal
to] 5, 36% (95% CI 33-39) of Canadian adults could be classified as
having dyslipidemia (Table 2). The prevalence of measured dyslipidemia
increased with age and was significantly more common in males (43%, 95%
CI 37-49) than in females (29%, 95% CI 25-33).
When the use of lipid-modifying medication was included in the
definition of dyslipidemia, the prevalence rose to 45% (95% CI 42-48)
(Table 3). The majority (81%, (8.5/10.5), 95% CI 74-86) of those taking
medication had their lipid levels under high levels (i.e., LDL-C<3.5
and TC/HDL-C ratio<5). However, only 24% (10.5/44.6, 95% CI 20-27) of
those with dyslipidemia reported medication use. When we consider the
total population with dyslipidemia, including those taking
lipid-modifying drugs, only 19% (8.5/44.6, 95% CI 16-22) of those with
dyslipidemia had their lipids under desirable levels. Only 18%
(8.5/47.3, 95% CI 11-28) of participants aged 40 to 59 years were taking
medication for their dyslipidemia, while for those aged 60 to 79 years,
the percentage taking medication was 48% (33.1/69.2, 95% CI 41-54).
Only 39% (95% CI 34-44) of those who had high lipid levels reported
on the questionnaire that they had been told by a health care
professional that their cholesterol was high, while 57% (95% CI 52-63)
were not aware of their condition and 4% (95% CI 2-7) were taking
medication for their condition, yet did not report being aware of it
(Table 4). Awareness levels were similar in males and females and
increased with age.
Tables 5a and 5b present the proportion of the sample meeting the
2009 Canadian cardiovascular guidelines for the diagnosis and treatment
of dyslipidemia and the prevention and management of CVD. (5) For this
analysis, respondents were classified by their CVD risk status and 24%
of Canadians were at either moderate (10%, 95% CI 8-12) or high CVD risk
(14%, 12-16). Treatment initiation would be recommended in 80% (95% CI
71-86) of those at moderate CVD risk and in 5% (95% CI 4-8) of those at
low CVD risk (8.5% if the additional criteria suggested in the
guidelines of TC/HDL-C >6 are used, data not shown). The guidelines
recommend that treatment should be considered in all those at high risk.
Overall, lipid-modifying therapy was initiated in individuals where
treatment was recommended in 41% (95% CI 36-46) across all risk
categories, and in 49%, 20% and 54% of those at high, moderate, and low
risk levels respectively (falls from 54% to 35% in the low-risk group if
we include TC/HDL-C >6, data not shown). In these risk categories
where treatment initiation is recommended, participants reported overall
low levels of awareness (of having been told they had high cholesterol).
The overall awareness was 53% (95% CI 47-60) and was lowest in the
moderate risk group (43%, 95% CI 33-54).
In terms of reaching treatment targets in the different risk
categories where treatment initiation would be recommended, only 41%
(95% CI 31-53) of those taking lipid-modifying medication achieved the
recommended target of LDL-C <2 mmol/L or ApoB <0.8 g/L. Only 24%
(95% CI 16-35) attained the LDL-C target and 40% (95% CI 30-50) the ApoB
target. Using a more conservative target for LDL-C, about 90% of those
on medication attained a LDL-C <3.5 mmol/L (data not shown).
Interpretation
Despite the recent decrease in mortality due to CVD,16 this study
shows that there is still a high proportion of Canadians at high risk of
CVD with dyslipidemia who are not being treated to recommended levels.
More than a third of the adult population (36%) has measured
dyslipidemia, a slight improvement from the 19861992 CHHS data (separate
analyses by MJ) where 39% would have been classified with dyslipidemia
using the same criteria, while no improvement is apparent if we include
individuals taking lipid-modifying medication in the definition (CHMS:
45% vs. CHHS: 44%). Even though 81% of those on medication were under
LDL-C <3.5 mmol/L and TC/HDL-C <5, the overall proportion of
individuals either treated or with high lipid levels who are below these
levels is only 19%. This is significant as it has been estimated that a
1 mmol/L decrease in LDL-C, that is sustained for 5 years, may result in
a reduction in CVD events of about 23%. (17)
NHANES data (18) show a decrease in LDL-C (using a 3.36 mmol/L
cut-point) between the latest NHANES surveys and the 1999-2006 NHANES,
from 41% to 36%. However, there is no change in high LDL-C levels
between the CHHS and the CHMS (32% [greater than or equal to] 3.5 mmol/L
for both surveys). Direct comparisons with NHANES using the same
criteria are warranted.
The 2009 guidelines do not provide simple criteria based on lipid
levels for the diagnosis of dyslipidemia. They stratify individuals by
their overall CVD risk score based on Framingham and the Reynolds risk
score and then recommend initiation of treatment by lipid levels, family
history and hs-CRP. Therefore we can assume that the diagnosis of
dyslipidemia is defined in these guidelines by the algorithm leading to
treatment initiation in these CVD risk categories.
By these criteria, about a quarter of participants (26%) are
classified as requiring therapy across all levels of CVD risk. Of those
for whom treatment initiation is recommended, only 41% were taking a
lipid-modifying treatment, and only 24% of those reached a target LDL-C
level and 40% a target ApoB level. While treatment initiation therapy
would be recommended in 80% of those at moderate CVD risk, only 20% were
currently under lipid-modifying therapy. For individuals at high risk,
about half were treated (49%), and only 30% reached a target LDL-C level
and 47% a target ApoB level. Overall levels of awareness were low, and
almost half (47%, i.e., 100%-53%) of those for whom treatment initiation
was recommended were not aware that they had dyslipidemia.
Many experts suggest that ApoB is a better marker than LDL-C for
CVD and a better index of the adequacy of LDL-C lowering therapy than
LDL-C. (5) One of the strengths of the CHMS was the ability to estimate
those at high risk who were able to reach treatment targets using ApoB.
It is interesting to note that the proportion of individuals reaching a
target LDL-C <3.5 mmol/L is lower than those reaching an ApoB <0.8
g/L. It will be important to define which cut-off point for these two
targets should be used in future guidelines to assess control.
There were a few limitations to this study. First, due to sample
size limitations, we had small numbers and large confidence intervals
for some of the estimates by CVD risk status. Awareness levels relied on
whether respondents were told by a health professional that they had
high levels of cholesterol. Therefore, there may have been some
misclassification of awareness due to recall bias. Also, some
individuals may have been recently told that their lipid levels were
high and just started pharmacological or non-pharmacological treatment.
However, this would likely have only a small impact on the estimates.
Non-pharmacological treatment was not included in the estimates of
treatment prevalence and control since these guidelines focus on
treatment with both medications and health behaviours. Health behaviour
modifications have been deemed to be a cornerstone of CVD prevention,
and are central in the 2009 guidelines, as well as in the new 2013
guidelines. (19) While it would have been useful to get an estimate of
the level of adherence to health behaviour recommendations, this would
have required an additional complex survey to ascertain. Other factors
could have been considered in the assessment of risk if we were to
follow the 2009 guidelines and/or alternate targets and surrogate
markers of CVD. However these surrogate markers may be more relevant for
individual-level classification and should not significantly affect
results. In particular, to assess the level of "control", we
were not able to include in our calculation the primary target decrease
of 50% of LDL-C at all risk levels. Self-reported data were used for
heart disease, heart attack, and stroke as a proxy for coronary artery
disease, peripheral vascular disease, and atherosclerosis.
Results of this study suggest that there have been small
improvements in reducing, treating and controlling dyslipidemia in the
Canadian population since the 1980s. The situation seems to be similar
to that of the 1990s with hypertension, where we had low levels of
awareness, treatment and overall control of this condition. (20) While
we had a remarkable improvement in the level of treatment and control of
hypertension since the last Canadian survey (CHHS), (21) these data
suggest that this has not been paralleled in the lipids context. Given
the effectiveness of treatment of dyslipidemia, the potential exists to
achieve a better control of the condition in Canada. While this paper is
based on the 2009 guidelines, which were not available at the time of
this study, the 2012 guidelines (19) have a few changes that could
slightly affect our current estimates. Some of these changes include:
using non-HDL-C as alternate lipid markers; removing hsCRP and the Total
Cholesterol-HDL-C ratio as alternate targets; and addition of chronic
kidney disease as a high-risk feature.
Despite some study limitations, we were able to use the major 2009
guideline criteria to classify individuals in the different risk,
treatment, and control categories, including ApoB, hs-CRP, family
history, and the Framingham and Reynolds computed CVD risk levels. These
data represent a comprehensive assessment of dyslipidemia prevalence,
treatment and control, and prevalence of CVD risk in the Canadian
population; they show critical gaps, can be integrated into the C-CHANGE
initiative, (22) and will be an important baseline for assessing
progress in this area.
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Received: November 29, 2012
Accepted: March 13, 2013
Michel Joffres, MD, PhD, [1] Margot Shields, [2] Mark S. Tremblay,
PhD, [3] Sarah Connor Gorber, PhD [4]
Author Affiliations
[1.] Faculty of Health Sciences, Simon Fraser University, Burnaby,
BC
[2.] Senior Analyst, Health Analysis, Statistics Canada, Ottawa, ON
[3.] Healthy Active Living and Obesity Research Group, CHEO
Research Institute, University of Ottawa, Ottawa, ON
[4.] Public Health Agency of Canada, Ottawa, ON
Correspondence: Dr. Michel Joffres, Faculty of Health Sciences,
Blusson Hall,
Simon Fraser University, 8888 University Drive, Burnaby, BC V5A
1S6, Tel: 778-782-7191, Fax: 778-782-5927, E-mail:
[email protected]
Conflict of Interest: None to declare.
Table 1. Criteria for Determining Risk of Cardiovascular Disease,
Treatment Initiation and Treatment Targets Using the 2009
Guidelines for the Diagnosis and Treatment of Dyslipidemia
Criteria for determining risk of CVD
High risk--any one Moderate risk Low risk
of the following
--coronary artery --Framingham risk --Framingham risk
disease score 10% to 19% score <10%
-- peripheral
vascular disease
--atherosclerosis
--most patients
with diabetes (men
>45 and women >50
years)
--Framingham risk
score (12) [greater
than or equal to]20%
--Reynolds risk
score (13) [greater
than or equal to]20%
Criteria for determining whether treatment
initiation is recommended, by risk category
High risk Moderate risk Low risk
--Consider treatment --LDL-C [greater than --LDL-C [greater
in all patients or equal to] ([dagger]) than or equal to]
3.5 mmol/L 5 mmol/L
--TC/HDL-C [greater
than or equal to] 5
--hs-CRP >2 mg/L in --(supplementary
men older than 50 and guideline--consider
in women older than treatment if
60 years of age TC/HDL-C >6)
--Family history and
hs-CRP risk (RRS
[greater than or
equal to] 10)
Primary treatment targets, by risk levels
High risk Moderate risk Low risk
-- LDL-C <2 mmol/L --LDL-C <2 mmol/L or a --a reduction in
or a reduction in reduction in LDL-C LDL-C of [greater
LDL-C of [greater of [greater than or than or equal to]
than or equal to]50% equal to] 50% 50% (not available)
([double dagger])
--Apolipoprotein --Apolipoprotein
B <0.8 g/L B <0.8 g/L
([dagger]) For all measures but hs-CRP, where the guidelines had >
we used [greater than or equal to].
([double dagger]) Reduction in LDL-C of 50% not available.
RRS = Reynolds risk score.
Table 2. Percentage With Dyslipidemia, by
Sex and Age Group, Household Population
Aged 20 to 79 years, Canada, 2007-2009
TC/HDL-C Ratio
[greater than or
equal to] 5
% 95% CI
Total 17.3 14.1-21.0
Sex
Male ([dagger]) 24.4 19.2-30.5
Female 10.3 * 6.9-15.1
Age group (years)
20-39 12.4 * 9.1-16.7
40-59 ([dagger]) 20.2 15.8-25.5
60-79 20.5 16.6-24.9
LDL-C [greater than
or equal to] 3.5
mmol/L
% 95% CI
Total 31.6 27.8-35.7
Sex
Male ([dagger]) 36.1 29.2-43.5
Female 27.3 * 23.5-31.4
Age group (years)
20-39 23.2 * 18.5-28.7
40-59 ([dagger]) 36.6 31.1-42.6
60-79 37.1 30.9-43.7
TC/HDL-C Ratio
[greater than
or equal to] 5 or
LDL-C [greater than
or equal to] 3.5
mmol/L
% 95% CI
Total 36.0 33.0-39.2
Sex
Male ([dagger]) 43.2 37.4-49.2
Female 29.0 * 25.3-33.1
Age group (years)
20-39 27.9 * 23.5-32.7
40-59 ([dagger]) 40.9 36.5-45.4
60-79 41.3 36.4-46.4
([dagger]) Reference category.
* Significantly different from reference
category (p < 0.05).
Source: March 2007 to February 2009
Canadian Health Measures Survey.
Table 3. Percent With High Lipid Levels ([dagger]), by Sex and
Age Group, Household Population Aged 20 to 79 Years, Canada,
2007-2009
Total Treated With Medication
Total
% 95% CI % 95% CI
Total Sex 44.6 41.6-47.6 10.5 9.1-12.1
Male ([double 52.8 47.5-58.0 12.5 10.4-15.1
dagger])
Female 36.5 * 32.6-40.6 8.5 * 7.1-10.2
Age group (years)
20-39 28.1 * 23.8-32.9 0.4 * (F) 0.1-1.6
40-59 ([double 47.3 42.1-52.6 8.5 5.0-14.1
dagger])
60-79 69.2 * 65.7-72.5 33.1 * 28.0-38.6
Treated With Medication
Measured--Not High Measured High
TC/HDL-C ratio < 5 TC/HDL-C ratio
and LDL-C [greater than
< 3.5 mmol/L or equal to]
5 or LDL-C
[greater than
or equal to]
3.5 mmol/L
% 95% CI % 95% CI
Total Sex 8.5 7.4-9.9 2.0 1.3-2.9
Male ([double 9.6 7.5-12.2 2.9 2.0-4.3
dagger])
Female 7.5 6.2-9.0 1.1 * (F) 0.4-2.5
Age group (years)
20-39 0.2 * (F) 0.0-1.5 0.2 * (F) 0.0-1.4
40-59 ([double 6.5 4.0-10.3 2.0 (F) 0.9-4.6
dagger])
60-79 27.9 * 23.6-32.6 5.2 3.3-8.1
Not Treated
Measured High
TC/HDL-C ratio
[greater than
or equal to] 5
or LDL-C
[greater than
or equal to]
3.5 mmol/L
% 95% CI
Total Sex 34.0 31.1-37.1
Male ([double 40.3 34.6-46.2
dagger])
Female 28.0 * 24.7-31.5
Age group (years)
20-39 27.7 * 23.4-32.5
40-59 ([double 38.8 34.3-43.5
dagger])
60-79 36.1 31.6-40.9
([dagger]) Measured TC/HDL cholesterol ratio
[greater than or equal to] 5, or LDL cholesterol
[greater than or equal to] 3.5 mmol/L, or
lipid-modifying medication in the previous month.
([double dagger]) Reference category.
* Significantly different from reference category
(p < 0.05).
(F) Due to high sampling variance (coefficient of
variation [greater than or equal to] 33.3%), this
estimate does not meet Statistics Canada's quality
standards.
Source: March 2007 to February 2009 Canadian
Health Measures Survey.
Table 4. Percent With High Lipid Levelst Who Are Aware and Using
Lipid-modifying Medication, by Sex and Age Group, Household
Population Aged 20 to 79 Years With High Lipids, Canada,
2007-2009
Aware Not Aware
(self-reported but Taking
high cholesterol) Lipid-modifying
Medication
% 95% CI % 95% CI
Total 38.8 33.8-44.0 3.9 2.1-7.1
Sex
Male ([double 37.2 31.1-43.7 4.0 2.5-6.5
dagger])
Female 41.0 34.6-47.7 3.6 (F) 1.3-9.8
Age group (years)
20-39 11.6 * 4.2-28.3 0.8 (F) 0.1-5.4
40-59 ([double 39.7 32.5-47.3 2.6 (F) 0.9-7.2
dagger])
60-79 57.8 * 51.2-64.2 7.8 3.8-15.5
Not Aware and
Not Taking
Lipid-modifying
Medication
% 95% CI
Total 57.4 51.8-62.7
Sex
Male ([double 58.8 51.7-65.5
dagger])
Female 55.4 48.6-61.9
Age group (years)
20-39 87.6 * 73.8-94.7
40-59 ([double 57.7 48.9-66.1
dagger])
60-79 34.4 * 29.1-40.1
([dagger]) Measured TC/HDL-C cholesterol ratio [greater than or
equal to] 5, or LDL cholesterol [greater than or equal to] 3.5
mmol/L, or lipid-modifying medication in the previous month.
([double dagger]) Reference category.
* Significantly different from reference category (p<0.05).
(F) Due to high sampling variance (coefficient of variation
>33.3%), this estimate does not meet Statistics Canada's quality
standards.
Source: March 2007 to February 2009 Canadian Health Measures
Survey.
Table 5a. Adherence With 2009 Target Lipid Levels, Household
Population Aged 20 to 79 years, Canada, 2007-2009
Percentage % for Whom
Distribution Treatment
by Risk Level Initiation
Is Recommended
([dagger])
% 95% CI % 95% CI
Total 25.8 22.5-29.4
Risk level
Low 76.2 73.5-78.6 5.4 3.6-8.1
Moderate 10.1 8.3-12.3 79.6 71.2-85.9
High 13.7 11.9-15.8 100.0
% Taking % Aware ([double
Lipid-modifying dagger])
Medication (self-reported
([double dagger]) high cholesterol)
% 95% CI % 95% CI
Total 40.9 35.8-46.2 53.3 46.5-59.9
Risk level
Low 54.4 41.1-67.2 63.0 40.6-80.9
Moderate 20.0 11.4-32.8 43.3 32.8-54.5
High 48.9 42.9-54.9 56.1 49.4-62.6
% With LDL Cholesterol <2 mmol/L Among
Those:
Taking Not Taking
Lipid-modifying Lipid-modifying
Medication Medication
Treatment
Initiation
Recommended
% 95% CI % 95% CI
Total 23.8 15.5-34.8 3.1 (F) 1.2-7.9
Risk level
Low 17.0 (F) 4.8-45.7 0.0
Moderate 7.7 (F) 1.2-35.8 2.7 (F) 0.6-12.0
High 29.9 18.9-43.8 4.3 (F) 1.8-9.7
% With LDL
Cholesterol
<2 mmol/L Among
Those:
Not Taking
Lipid-modifying
Medication
Treatment
Initiation
Not Recommended
% 95% CI
Total 14.7 12.1-17.8
Risk level
Low 14.6 11.9-17.9
Moderate 18.0 (F) 5.6-44.8
High
([dagger]) Includes those taking lipid-modifying medication.
([double dagger]) Among those for whom treatment initiation
is recommended/are taking lipid-modifying medication.
Note: If coefficient of variation is greater than 33.3%,
estimate is indicated as being less than upper limit of 95%
confidence interval.
Source: March 2007 to February 2009 Canadian Health Measures
Survey.
Table 5b. Adherence With 2009 Target Lipid Levels, Household Population
Aged 20 to 79 Years, Canada, 2007-2009
% With Apolipoprotein B (apoB)
<0.8 g/L Among Those:
Taking Not Taking Lipid-modifying
Lipid-modifying Medication
Medication
Treatment Treatment
Initiation Initiation Not
Recommended Recommended
% 95% CI % 0.95 % 95% CI
Total 39.6 29.7-50.5 5.9 3.0-11.3 38.6 32.4-45.2
Risk level
Low 26.1 F 10.8-50.8 0 38.2 32.0-44.8
Moderate 26.9 F 10.8-52.8 3.4 F 1.0-10.7 51.7 26.9-75.7
High 47.1 32.3-62.5 9.7 4.7-18.7
% With LDL Cholesterol <2 mmol/L or
Apolipoprotein B (apoB) <0.8 g/L Among Those:
Taking Not Taking Lipid-modifying
Lipid-modifying Medication
Medication
Treatment Treatment
Initiation Initiation Not
Recommended Recommended
% 95% CI % 95% CI % 95% CI
Total 41.5 30.9-52.9 5.9 3.0-11.3 39.1 33.3-45.2
Risk level
Low 26.1 F 10.8-50.8 0 38.7 32.9-44.9
Moderate 28.0 F 11.9-52.7 3.4 F 1.0-10.7 51.7 26.9-75.7
High 49.8 33.9-65.7 9.7 4.7-18.7
% With LDL Cholesterol
<3.5 mmol/L Among Those:
Taking Not Taking Lipid-modifying
Lipid-modifying Medication
Medication
Treatment Treatment
Initiation Initiation Not
Recommended Recommended
% 95% CI % 95% CI % 95% CI
Total 89.6 80.7-94.7 28.4 22.3-35.5 73.6 69.5-77.4
Risk level
Low 86.3 72.4-93.8 0 72.9 68.6-76.8
Moderate 90 67.2-97.6 21.5 13.9-31.7 100
High 90.6 73.8-97.1 42.3 33.5-51.6
([dagger]) Includes those taking lipid-modifying medication.
([double dagger]) Among those for whom treatment initiation
recommended/are taking lipid-modifying medication.
Note: If coefficient of variation is greater than 33.3%, estimate is
indicated as being less than upper limit of 95% confidence interval.
Source: March 2007 to February 2009 Canadian Health Measures Survey.
