High total serum cholesterol, medication coverage and therapeutic control: an analysis of national health examination survey data from eight countries

objective: to determine the fraction of individuals with high total serum cholesterol who get diagnosed and effectively treated in eight high- and middle-income countries. methods: using data from nationally representative health examination surveys conducted in 1998-2007, we studied a probability sample of 79 039 adults aged 40-79 years from england, germany, japan, jordan, mexico, scotland, thailand and the united states of america. for each country we calculated the prevalence of high total serum cholesterol (total serum cholesterol > 6.2 mmol/l or > 240 mg/dl) and the mean total serum cholesterol level. we also determined the fractions of individuals being diagnosed, treated with cholesterol-lowering medication and effectively controlled (total serum cholesterol < 6.2 mmol/l or < 240 mg/dl). findings: the proportion of undiagnosed individuals was highest in thailand (78%; 95% confidence interval, ci: 74-82) and lowest in the united states (16%; 95% ci: 13-19). the fraction diagnosed but untreated ranged from 9% in thailand (95% ci: 8-11) to 53% in japan (95% ci: 50-57). the proportion being treated who had attained evidence of control ranged from 4% in germany (95% ci: 3-5) to 58% in mexico (95% ci: 54-63). time series estimates showed improved control of high total serum cholesterol over the past two decades in england and the united states. conclusion: the percentage of people with high total serum cholesterol who are effectively treated remains small in selected high- and middle-income countries. many of those affected are unaware of their condition. untreated high blood cholesterol represents a missed opportunity in the face of a global epidemic of chronic diseases.