Cholesterol in the U.S. 2025
Cholesterol continues to be a major public health issue in the United States in 2025, closely linked to the nation’s ongoing battle against heart disease—the leading cause of death. Despite decades of public health campaigns and medical advances, millions of American adults still live with high total cholesterol or dangerously low levels of HDL (“good”) cholesterol. These abnormal cholesterol levels significantly raise the risk of cardiovascular events like heart attacks and strokes, particularly in middle-aged and older populations. Understanding current cholesterol trends is critical for guiding prevention strategies and improving long-term health outcomes.
Recent data from the National Health and Nutrition Examination Survey (NHANES) reveals that over 11% of U.S. adults have high total cholesterol, while nearly 14% have low HDL cholesterol, with men and middle-aged individuals disproportionately affected. Although there have been significant improvements over the past two decades, recent years have shown a plateau or even slight reversal in progress. This signals an urgent need to refocus public health efforts, especially on preventive care, routine screening, and lifestyle interventions that address both dietary habits and physical inactivity.
Cholesterol Statistics in the U.S. 2025
High Total Cholesterol in the US (2021–2023)
High Total Cholesterol by Demographics
| Demographic Group | Prevalence (%) | Key Findings |
|---|---|---|
| Overall Adults (20+) | 11.3% | No significant gender difference |
| Men | 10.6% | Slightly lower than women |
| Women | 11.9% | Slightly higher than men |
| Ages 20–39 | 6.0% | Lowest prevalence group |
| Ages 40–59 | 16.7% | Highest prevalence group |
| Ages 60+ | 11.3% | Moderate prevalence |
Note: High total cholesterol is defined as a serum total cholesterol level of 240 mg/dL or higher.
The latest NHANES data from 2021 to 2023 shows that 11.3% of adults aged 20 and older in the United States have high total cholesterol. This condition is nearly evenly distributed between men (10.6%) and women (11.9%), with women showing a slightly higher prevalence. The highest-risk age group is 40 to 59 years, where nearly 1 in 6 adults are affected. Conversely, the 20–39 age group shows the lowest prevalence at just 6.0%, reinforcing the importance of early prevention before middle age.
What’s particularly notable is the return to moderate levels in the 60+ group (11.3%), which matches the national average. This suggests that some older adults may benefit from cholesterol-lowering medications or improved health behaviors, but it also highlights the persistent need for cholesterol management into later life. Gender differences appear minor overall but become more pronounced with age, especially in senior populations.
Age and Gender Patterns in High Cholesterol (US, 2021–2023)
Age and Gender Patterns
| Age Group | Men (%) | Women (%) | Gender Difference |
|---|---|---|---|
| 20–39 years | Higher | 6.0% | Men > Women |
| 40–59 years | 16.7% | 16.7% | Similar levels |
| 60+ years | Lower | Higher | Women > Men |
The gender-specific data highlights evolving trends across the lifespan. Among young adults (20–39), men have higher rates of high cholesterol compared to women, suggesting early cardiovascular risk patterns are more prevalent in males. This could be linked to lifestyle behaviors such as poor diet, smoking, or lack of exercise. In the 40–59 age group, both men and women have the same rate—16.7%—demonstrating that this life stage is universally vulnerable to cholesterol buildup, likely due to metabolic changes, stress, and reduced physical activity.
In older adults aged 60 and above, the pattern shifts—women overtake men in prevalence of high cholesterol. This may be due to post-menopausal changes in lipid metabolism, which elevate cholesterol levels. The data also suggests older women may not be achieving the same treatment outcomes or lifestyle adjustments as their male counterparts, making them a key target for intervention strategies.
Low HDL Cholesterol in the US (2021–2023)
Low HDL-C Prevalence by Demographics
| Demographic Group | Prevalence (%) | Risk Level |
|---|---|---|
| Overall Adults | 13.8% | Moderate concern |
| Men | 21.5% | High concern |
| Women | 6.6% | Lower concern |
| Ages 20–39 | 16.2% | Highest in life |
| Ages 40–59 | 13.4% | Moderate |
| Ages 60+ | 11.2% | Lowest in life |
Note: Low HDL-C is defined as serum HDL-C less than 40 mg/dL.
Low levels of HDL cholesterol—often referred to as “good” cholesterol—pose serious health concerns because HDL helps remove excess cholesterol from the bloodstream. According to NHANES data (2021–2023), 13.8% of U.S. adults have low HDL-C levels, but the disparity by gender is striking. Men (21.5%) are over three times more likely to have low HDL-C compared to women (6.6%), which may partially explain men’s higher cardiovascular risk.
Age also plays a role in low HDL-C prevalence. Younger adults (20–39) exhibit the highest rates of low HDL-C at 16.2%, followed by 40–59-year-olds (13.4%), and then older adults (11.2%). These trends suggest that HDL levels improve with age, potentially due to health-conscious behaviors adopted later in life or age-related metabolic shifts. However, the high prevalence in younger age groups is concerning, as it may signal future cardiovascular events if early intervention is not taken.
Gender Disparities in Low HDL-C (US, 2021–2023)
Gender Disparities by Age Group
| Age Group | Men (%) | Women (%) | Gender Gap (pp) |
|---|---|---|---|
| 20–39 years | 25.1% | 7.6% | 17.5 |
| 40–59 years | 21.2% | 6.1% | 15.1 |
| 60+ years | 17.9% | 5.2% | 12.7 |
Gender disparities in low HDL-C are consistent and significant across all age groups. In the 20–39 age group, men have a 25.1% prevalence, compared to just 7.6% for women, a difference of 17.5 percentage points. This stark gap is mirrored in other age brackets as well—among those aged 40–59, the gap is 15.1 points, and among those 60+, it’s still a substantial 12.7 points.
These findings indicate that men are consistently at higher risk for low HDL-C, regardless of age. This could stem from a combination of biological factors and lifestyle choices, such as higher rates of smoking, unhealthy diets, or lower levels of physical activity in men. It also underscores the urgent need for male-targeted cholesterol screening and public health education, particularly in early adulthood when the gap is widest.
Historical Cholesterol Trends in the US (1999–2023)
High Total Cholesterol Trends (US, 1999–2023)
| Time Period | Prevalence (%) | Trend Direction |
|---|---|---|
| 1999–2000 | 18.3% | Starting point |
| 2007–2008 | 15.0% | Declining |
| 2013–2014 | 11.0% | Continued decline |
| 2017–2020 | 10.0% | Plateau |
| 2021–2023 | 11.2% | Slight increase |
Between 1999 and 2000, 18.3% of U.S. adults had high total cholesterol, marking the starting point of recorded national cholesterol surveillance. A strong downward trend followed, with prevalence decreasing to 15.0% by 2007–2008, then further dropping to 11.0% by 2013–2014. This decline reflected public health successes in statin usage, awareness campaigns, and dietary improvements. However, the pace of progress slowed, and between 2017 and 2020, prevalence stalled at 10.0%, signaling the beginning of a plateau.
In the latest period, from 2021 to 2023, high cholesterol rates edged back upward to 11.2%, showing a slight increase after years of decline. The trend direction data underscores this shift: while previous years were marked as “declining” or “continued decline,” the most recent trend is classified as a “slight increase.” This reversal may suggest lifestyle regression, reduced screening, or rising obesity and dietary fat intake. The data confirms that although improvements were made over the last two decades, vigilance is needed to prevent further regression.
Low HDL Cholesterol Trends in the US (2007–2023)
Low HDL-C Trends (US, 2007–2023)
| Time Period | Prevalence (%) | Change |
|---|---|---|
| 2007–2008 | 22.2% | Baseline |
| 2013–2014 | 18.8% | -3.4% decrease |
| 2017–2020 | 16.5% | -2.3% decrease |
| 2021–2023 | 14.2% | -2.3% decrease |
In 2007–2008, low HDL cholesterol — defined as HDL-C below 40 mg/dL — affected 22.2% of American adults. This serves as the baseline period for evaluating change. Over the next several years, the prevalence dropped significantly. By 2013–2014, it had decreased to 18.8%, a -3.4% reduction. Continued improvements were observed in 2017–2020, when rates fell to 16.5%, representing a -2.3% decline from the prior period.
The most recent data from 2021–2023 shows further reduction, with prevalence falling to 14.2% — another -2.3% decrease. Although the overall trend shows steady improvement, the pace of change has slowed in recent cycles. The decline from 22.2% in 2007–2008 to 14.2% in 2021–2023 totals a 36% drop, which is notable. However, the recurring -2.3% drops indicate that while public health messaging and treatment strategies have been effective, further reductions may require more targeted interventions.
National Mean Cholesterol Levels in the US (2017–2020)
Average Cholesterol Measures (US, 2017–2020)
| Measurement | Value | Assessment |
|---|---|---|
| Mean Total Cholesterol | 187 mg/dL | Within normal range |
| Optimal Level | <200 mg/dL | Most Americans meet this |
| Borderline High | 200–239 mg/dL | At-risk segment present |
| High Level | ≥240 mg/dL | 10.0% of population |
The national mean total cholesterol for U.S. adults between 2017 and 2020 was 187 mg/dL, placing it within the normal range. Most Americans were below the optimal level of 200 mg/dL, a strong public health marker showing good baseline lipid control for much of the population. This suggests that broad-scale efforts to reduce cholesterol through diet, exercise, and statins have been moderately successful.
However, a significant number of individuals still face elevated risk. A sizable segment falls into the borderline high range of 200–239 mg/dL, representing those on the cusp of high cholesterol who may require intervention. Additionally, 10.0% of the U.S. population had high cholesterol levels of 240 mg/dL or greater, posing serious cardiovascular risks. While average levels may look favorable, these hidden at-risk groups need closer monitoring and clinical follow-up.
Cholesterol Screening and Clinical Impact in the US (2021–2023)
Healthcare System Metrics (US, 2021–2023)
| Healthcare Metric | Percentage | Implication |
|---|---|---|
| Office visits with cholesterol screening | 6.9% | Screening opportunity |
| Visits with hyperlipidemia diagnosis | 20.5% | Treatment prevalence |
| Routine screening compliance | Variable | Room for improvement |
During 2021–2023, only 6.9% of office visits in the United States included a cholesterol screening, signaling a major missed opportunity in preventive care. This low percentage is especially concerning when considered alongside the 20.5% of visits where patients were diagnosed with hyperlipidemia. This suggests that cholesterol is often only addressed after problems arise, rather than caught early through proactive screening.
Routine screening compliance remains variable, meaning that while some patient groups are regularly monitored, many others are not receiving consistent lipid assessments. These gaps in preventive healthcare lead to undetected risk and missed interventions. The data highlights the need to significantly increase cholesterol testing as a public health priority, particularly for individuals with family history, obesity, or other cardiovascular risks.
Cholesterol Risk Factors and Demographics in the US
High-Risk Populations
| Population Group | Risk Level | Contributing Factors |
|---|---|---|
| Men aged 40–59 | Highest | Peak working years, lifestyle |
| Adults 40–59 overall | High | Metabolic changes |
| Men (all ages) | Elevated | Gender-specific risks |
| Older women (60+) | Moderate–High | Post-menopausal changes |
Cholesterol-related risks in the United States in 2025 remain highly influenced by age and gender patterns. Men aged 40–59 are the highest risk group, facing compounded threats from lifestyle factors common in this life stage such as stress, poor diet, lack of exercise, and long work hours. When extended to all adults aged 40–59, the risk remains high, driven by metabolic transitions like rising insulin resistance, increased visceral fat, and higher blood pressure—all of which contribute to dyslipidemia.
In broader demographic terms, men across all age brackets continue to experience elevated cholesterol risk, linked to biological factors such as lower baseline HDL-C levels, as well as behaviors like smoking and lower healthcare utilization. Among older women aged 60+, the risk is categorized as moderate to high, especially due to post-menopausal hormonal shifts, which tend to decrease HDL and increase LDL cholesterol. These findings stress the importance of targeted prevention programs that consider gender-specific physiology and age-based risk progression.
Cholesterol Control Progress and Challenges in the US
| Achievement | Impact |
|---|---|
| 37% reduction | High cholesterol since 1999 |
| 36% reduction | Low HDL-C since 2007 |
| Maintained improvements | No return to historical highs |
The United States has made remarkable progress in combating high cholesterol over the last two decades. Since 1999, there has been a 37% reduction in the national prevalence of high total cholesterol, highlighting the success of widespread public health initiatives, statin therapy, and evolving dietary guidelines. Similarly, low HDL-C prevalence has declined by 36% since 2007, pointing to modest but sustained improvements in lipid health and awareness.
Perhaps most notably, these gains have been maintained, with no return to historical highs in recent data cycles. This consistent plateau suggests that although progress has stalled somewhat, the country has not regressed into earlier risk levels seen in the late 1990s or early 2000s. Still, the slow-down in momentum means that renewed intervention strategies are required to push national cholesterol metrics toward more optimal ranges—especially among high-risk groups.
Cholesterol Concerns and Screening Gaps in the US
Areas of Concern
| Challenge | Details |
|---|---|
| Plateau effect | Limited gains since 2013–2014 |
| Gender disparities | Men have 3x higher low HDL-C rates |
| Age patterns | Risk peaks in middle-aged adults |
| Screening gaps | Only 6.9% of office visits include screening |
Despite earlier progress, several critical challenges are limiting further cholesterol control in 2025. The first is the plateau effect—national high cholesterol and low HDL-C rates have made no significant gains since 2013–2014, indicating that previous strategies may have reached their limit. A major gender disparity persists as well: men are three times more likely to have low HDL-C than women, a trend that has remained unchanged for years.
Age-related patterns continue to reflect heightened vulnerability during middle adulthood, particularly in the 40–59 age range. Meanwhile, preventive screening remains deeply underutilized: only 6.9% of office visits include a cholesterol check, leaving many cases undiagnosed. These combined factors emphasize the urgent need for refined targeting, equity-focused approaches, and expanded screening access to regain the momentum in improving national cholesterol outcomes.
Cholesterol Public Health Priorities in the US
Public Health Priorities
| Priority Area | Action Needed |
|---|---|
| Preventive screening | Expand access and screening frequency |
| Middle-aged focus | Tailored interventions for 40–59 age group |
| Men’s health | Address low HDL-C disparity |
| Lifestyle interventions | Promote diet, exercise, and smoking cessation |
In 2025, the public health response to cholesterol must evolve to match the current demographic landscape and persistent gaps in care. First, preventive screening must be expanded—both in terms of access and frequency. Making cholesterol tests a routine part of adult healthcare will be key to catching abnormalities early. Second, a dedicated middle-aged focus is needed, especially for adults aged 40–59, who show the highest risk rates for both high total cholesterol and low HDL-C.
Another major priority is addressing men’s health by targeting the disproportionate burden of low HDL-C among males. Tailored outreach and education campaigns, alongside clinical follow-up, can help close this gap. Finally, public health programs must reinforce lifestyle interventions that promote heart-healthy diets, physical activity, and tobacco cessation. These foundational behaviors remain the most cost-effective strategies for reducing population-wide cholesterol levels and long-term cardiovascular risk.
Conclusion
The United States has made meaningful progress in reducing high cholesterol prevalence, with levels falling from 18.3% in 1999–2000 to 11.3% in 2021–2023. Yet, the recent plateau highlights the need for renewed action. With more than 28 million adults still affected by high cholesterol and millions more at risk due to low HDL-C, prevention and management strategies remain crucial.
Efforts should now focus on expanding access to cholesterol screening, targeting middle-aged groups and men in particular, and strengthening lifestyle modification programs. Sustaining and extending these gains will be vital for reducing the burden of cardiovascular disease nationwide.
Disclaimer: The data research report we present here is based on information found from various sources. We are not liable for any financial loss, errors, or damages of any kind that may result from the use of the information herein. We acknowledge that though we try to report accurately, we cannot verify the absolute facts of everything that has been represented.
