Heart disease is the leading cause of death in the United States (Murphy, et. al., 2018). Blood lipid levels are fundamental measures included in NHANES that can be used for cardiovascular risk assessment. The goals of the NHANES blood lipid measurements include: 1) monitoring the prevalence and trends in major cardiovascular conditions and overall risk factors in the U.S.; 2) evaluating prevention and treatment programs targeting cardiovascular disease in the U.S.; and 3) monitoring the status of hyperlipidemia.
In 2018, new Blood Cholesterol Guidelines were released, by the American College of Cardiology and American Heart Association Task Force on Clinical Practice Guidelines, which aim to reduce the risk of atherosclerotic cardiovascular disease through cholesterol management (Grundy, et. al., 2018). The blood lipids measurements in NHANES include total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoproteins cholesterol (LDL-C), and triglycerides. The present file provides data on HDL-C. Data on total cholesterol are provided in Cholesterol - Total (TCHOL_J) file, and LDL-C and triglyceride data are provided in (TRIGLY_J).
Examined participants aged 6 years and older were eligible.
High-Density Lipoprotein (HDL)
This method to measure HDL-C uses a magnesium/dextran sulfate solution that is first added to the specimen to form water-soluble complexes with non-HDL cholesterol fractions. These complexes are not reactive with the measuring reagents added in the second step. With addition of reagent 2, HDL-cholesterol esters are converted to HDL-cholesterol by PEG-cholesterol esterase. The HDL-cholesterol is acted upon by PEG-cholesterol oxidase, and the hydrogen peroxide produced from this reaction combines with 4-amino-antipyrine and HSDA under the action of peroxidase to form a purple/blue pigment that is measured photometrically at 600 nm (secondary wavelength = 700 nm). When the cholesterol measuring enzymes are modified with PEG, they are preferentially more reactive with HDL-cholesterol than the other cholesterol fractions. This is an endpoint reaction that is specific for HDL-cholesterol. This 3rd generation method differs from 2nd generation assays in the type of buffer used in the reagents, and the concentration of the reagent components. The basic reaction principle is unchanged.
Refer to the Laboratory Method Files section for a detailed description of the laboratory methods used.
Serum HDL-C levels were calculated from directly measured values of total cholesterol, triglycerides, and LDL-C. Please see below the Data Processing and Editing section for more details. For laboratory methods used for total cholesterol and LDL-C and triglycerides, please refer to the accompanying documentation: TCHOL_J and TRIGLY_J.
There were no changes to the lab method, lab equipment, or lab site for this component in the NHANES 2017-2018 cycle.
Direct HDL Laboratory Procedure Manual (February 2020)
Serum specimens were processed, stored, and shipped to the University of Minnesota, Minneapolis, MN for analysis.
Detailed instructions on specimen collection and processing are discussed in the NHANES Laboratory Procedures Manual (LPM). Vials are stored under appropriate frozen (–30°C) conditions until they are shipped to University of Minnesota for testing.
The NHANES quality assurance and quality control (QA/QC) protocols meet the 1988 Clinical Laboratory Improvement Act mandates. Detailed QA/QC instructions are discussed in the NHANES LPM.
Mobile Examination Centers (MECs)
Laboratory team performance is monitored using several techniques. NCHS and contract consultants use a structured competency assessment evaluation during visits to evaluate both the quality of the laboratory work and the quality control procedures. Each laboratory staff member is observed for equipment operation, specimen collection and preparation; testing procedures and constructive feedback are given to each staff member. Formal retraining sessions are conducted annually to ensure that required skill levels were maintained.
NHANES uses several methods to monitor the quality of the analyses performed by the contract laboratories. In the MEC, these methods include performing blind split samples collected during “dry run” sessions. In addition, contract laboratories randomly perform repeat testing on 2% of all specimens.
NCHS developed and distributed a quality control protocol for all the contract laboratories, which outlined the use of Westgard rules (Westgard et al., 1981) when running NHANES specimens. Progress reports containing any problems encountered during shipping or receipt of specimens, summary statistics for each control pool, QC graphs, instrument calibration, reagents, and any special considerations are submitted to NCHS quarterly. The reports are reviewed for trends or shifts in the data. The laboratories are required to explain any identified areas of concern.
The data were reviewed. Incomplete data or improbable values were sent to the performing laboratory for confirmation.
One derived variable was created in this data file. The variable was created using the following formula:
HDL-cholesterol in mg/dL (LBXHDD) was converted to mmol/L (LBDHDDSI) by multiplying by 0.02586.
Refer to the 2017-2018 Laboratory Data Overview for general information on NHANES laboratory data.
There are over 800 laboratory tests performed on NHANES participants. However, not all participants provided biospecimens or enough volume for all the tests to be performed. The specimen availability can also vary by age or other population characteristics. For example, in 2017-2018, approximately 80% of children aged 1-17 years who were examined in the MEC provided a blood specimen through phlebotomy, while 95% of examined adults age 18 and older provided a blood specimen. Analysts should evaluate the extent of missing data in the dataset related to the outcome of interest as well as any predictor variables used in the analyses to determine whether additional re-weighting for item non-response is necessary.
Demographic and Other Related Variables
The analysis of NHANES laboratory data must be conducted using the appropriate survey design and demographic variables. The NHANES 2017-2018 Demographics File contains demographic data, health indicators, and other related information collected during household interviews as well as the sample design variables. The recommended procedure for variance estimation requires use of stratum and PSU variables (SDMVSTRA and SDMVPSU, respectively) in the demographic data file.
The Fasting Questionnaire File includes auxiliary information, such as fasting status, length of fast and the time of venipuncture.
This laboratory data file can be linked to the other NHANES data files using the unique survey participant identifier (i.e., SEQN).
The detection limit was constant for the analyte in the data set.
The lower limit of detection (LLOD, in mg/dL) for HDL-cholesterol:
|Code or Value||Value Description||Count||Cumulative||Skip to Item|
|10 to 189||Range of Values||6738||6738|
|Code or Value||Value Description||Count||Cumulative||Skip to Item|
|0.26 to 4.89||Range of Values||6738||6738|