Time trends in population cholesterol levels 1986–2004: influence of lipid‐lowering drugs, obesity, smoking and educational level. The northern Sweden MONICA study

Abstract. Objectives.  To explore time trends in population total cholesterol. Design and setting.  Five population‐based cross‐sectional surveys, 1986–2004 in the northern Sweden MONICA study included 8827 men and women. Results.  Age‐adjusted cholesterol level declined in men, 25–64 years old, from 6.38 to 5.78 mmol L −1 and in women from 6.32 to 5.51 mmol L −1 . Between 1994 and 2004, subjects 65–74 years old were included, and their levels also decreased, in men from 6.35 to 5.76 mmol L −1 and in women from 7.11 to 6.24 mmol L −1 . The decrease was continuous over surveys and age groups, except in young and middle‐aged men where no further decline was found after 1999. Cohorts born 1920–1939 showed decreased cholesterol over the period, whilst no change was noted for those born thereafter. In 2004, one‐fourth of men and one‐third of women 25–74 years achieved levels below 5.0 mmol L −1 . Subjects with low educational level, body mass index ≥25 or smokers all had higher cholesterol levels which persisted during the 18‐year period. In 2004, the 9% who used lipid‐lowering drugs are estimated to contribute, at most, to 0.13 mmol L −1 lower cholesterol in the population. Conclusion.  Large decreases in cholesterol levels occurred in the 18‐year period. Less smoking may contribute to, and increasing obesity attenuate, this trend whilst lipid‐lowering drugs have had little effect until recently. Socio‐economic inequalities persist.