Citation: Scientific Reports. 8(1):2782, 2018 Feb 09.Journal: Scientific reports.Published: 2018ISSN: 2045-2322.Full author list: Engeda JC; Holliday KM; Hardy ST; Chakladar S; Lin DY; Talavera GA; Howard BV; Daviglus ML; Pirzada A; Schreiner PJ; Zeng D; Avery CL.UI/PMID: 29426885.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Health Research InstituteActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access onlineDigital Object Identifier: https://dx.doi.org/10.1038/s41598-018-20660-2 (Click here)Abbreviated citation: Sci. rep.. 8(1):2782, 2018 Feb 09.Abstract: To examine the ability of total cholesterol (TC), a low-density lipoprotein cholesterol (LDL-C) proxy widely used in public health initiatives, to capture important population-level shifts away from ideal and intermediate LDL-C throughout adulthood. We estimated age (>=20 years)-, race/ethnic (Caucasian, African American, and Hispanic/Latino)-, and sex- specific net transition probabilities between ideal, intermediate, and poor TC and LDL-C using National Health and Nutrition Examination Survey (2007-2014; N=13,584) and Hispanic Community Health Study/Study of Latinos (2008-2011; N=15,612) data in 2016 and validated and calibrated novel Markov-type models designed for cross-sectional data. At age 20, >80% of participants had ideal TC, whereas the race/ethnic- and sex-specific prevalence of ideal LDL-C ranged from 39.2%-59.6%. Net transition estimates suggested that the largest one-year net shifts away from ideal and intermediate LDL-C occurred approximately two decades earlier than peak net population shifts away from ideal and intermediate TC. Public health and clinical initiatives focused on monitoring TC in middle-adulthood may miss important shifts away from ideal and intermediate LDL-C, potentially increasing the duration, perhaps by decades, that large segments of the population are exposed to suboptimal LDL-C.