55.32% of participants in a study of 18,074 adults in Iran met the criteria for .
Only 20.61% of individuals with hypercholesterolemia were receiving pharmacological treatment.
Treatment coverage was significantly lower in males (13.15%) compared to females (29.12%).
Among those receiving treatment, over half achieved optimal LDL levels (52.85% for females, 53.93% for males).
A majority reached total cholesterol levels below 200 mg/dL (76.98% of females, 81.06% of males).
Only 19.89% of females and 3.97% of males met the optimal HDL level goal.
57.79% of participants had a 10-year cardiovascular disease risk lower than 10%.
Simplified
INTRODUCTION: Noncommunicable diseases (NCDs), particularly cardiovascular disease (CVD), are the leading cause of death worldwide, with being a major risk factor for CVD. This study evaluated the hypercholesterolemia care cascade in Iran-including prevalence, diagnosis, treatment coverage, and effectiveness-using the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) guidelines.
METHODS: This cross-sectional study drew on data from the 2021 Iran STEPS survey, which employed a systematic cluster sampling of adults aged ≥ 18 years across all provinces in Iran. Hypercholesterolemia was defined per NCEP-ATP III thresholds (LDL ≥ 160 mg/dL, total cholesterol ≥ 240 mg/dL, HDL ≤ 40 mg/dL, or ongoing lipid-lowering therapy). Weighted descriptive statistics were calculated, and Poisson regression with robust variance estimated crude and adjusted prevalence ratios for optimal lipid control among those treated. The 10-year CVD risk was determined using the Framingham Risk Score, stratifying participants into low (< 10%), intermediate (10-20%), and high (> 20%) risk categories.
RESULTS: Out of 18,074 participants, 10,582 (55.32%, 95% CI: 54.29-56.35) met NCEP-ATP III criteria for hypercholesterolemia. Among these, only 20.61% (19.55-21.72) were receiving pharmacological treatment. Treatment coverage was notably lower in males (13.15%, 11.98-14.40) than females (29.12%, 27.35-30.96). Statins were the most commonly used medication (11.43% of males, 25.87% of females). Of those receiving treatment, 52.85% (females) and 53.93% (males) achieved optimal LDL, while 76.98% (females) and 81.06% (males) attained total cholesterol < 200 mg/dL. However, only 19.89% (females) and 3.97% (males) met the HDL > 60 mg/dL goal. The 10-year CVD risk was < 10% in 57.79% of participants, 10-20% in 33.27%, and > 20% in 8.94%.
CONCLUSION: Despite a high prevalence of hypercholesterolemia in Iran, treatment coverage remains suboptimal, particularly among males and working-age adults. Although most treated individuals achieve favorable LDL and total cholesterol levels, gaps persist in achieving optimal HDL targets. These findings underscore the need for strengthened screening, treatment, and adherence strategies-alongside broader preventive measures-to reduce the burden of hypercholesterolemia and CVD in Iran.
Key numbers
10,582 of 18,074 participants
Prevalence of
Participants meeting NCEP-ATP III criteria for
20.61%
Treatment Coverage
Percentage of individuals with receiving pharmacological treatment
52.85% of females and 53.93% of males
Optimal LDL Levels Achieved
Percentage of treated individuals achieving optimal LDL levels
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Declarations. Ethics approval and consent to participate: The research protocol for the study was approved by the Research Ethics Committees of the Endocrine & Metabolism Research Institute at Tehran University of Medical Sciences, with the approval number IR.TUMS.EMRI.REC.1402.017. Competing interests: The authors declare no competing interests.
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