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. 2009 Sep;2(5):443-50.
doi: 10.1161/CIRCOUTCOMES.108.847202. Epub 2009 Aug 18.

Trends in 10-year predicted risk of cardiovascular disease in the United States, 1976 to 2004

Francisco Lopez-Jimenez  1 , John A Batsis, Véronique L Roger, Lee Brekke, Henry H Ting, Virend K Somers
Affiliations

Trends in 10-year predicted risk of cardiovascular disease in the United States, 1976 to 2004

Francisco Lopez-Jimenez et al. Circ Cardiovasc Qual Outcomes. 2009 Sep.

Abstract

Background: There have been significant bidirectional changes in the prevalence of cardiovascular (CV) risk factors over time in the United States, making the net trend in risk for incident CV disease unknown. We assessed these trends by applying the Framingham Heart Study prediction model to national data.

Methods and results: The National Health and Nutrition Examination Survey (NHANES) II (1976-1980), NHANES III (1988-1994), and NHANES 1999-2004 are cross-sectional representative samples of the noninstitutionalized population of the United States. We excluded people with a history of CV disease, pregnant women, participants with missing CV risk factors data, and individuals outside the Framingham age range of 30 to 74 years. The Framingham risk function was used to estimate the 10-year risk for incident symptomatic CV disease. We calculated the slope of change or rate of change per year between NHANES II and III, and between NHANES III and 1999-2004. The difference between slopes was calculated and compared to zero. The average age-adjusted 10-year CV risk between NHANES II and III decreased from 10.0% to 7.9% between NHANES II and III, with a statistically significant slope (P<0.001). However, the average age-adjusted CV risk decreased at a lesser magnitude between NHANES III and NHANES 1999-2004 from 7.9% to 7.4% (P<0.001). These slopes were significantly different (P<0.0001). In women and middle-aged participants, CV risk did not change between NHANES III and NHANES 1999-2004 (P=0.40).

Conclusions: The estimated net risk for CV disease in the US population decreased from 1976-1980 to 1988-1994 but has changed minimally from 1988-1994 to 1999-2004, particularly in women and middle-aged people.

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Conflict of interest statement

DISCLOSURES There are no conflicts of interest or disclosures relevant to the subject of this manuscript.

Figures

Figure 1
Figure 1. Overall Trends in Cardiovascular Risk Factors – Males
Represents the change in prevalence over five common CV risk factors over time. Error bars represents risk score ± standard error of mean. The difference in prevalence of each individual risk factor between consecutive surveys and their overall trend are significant (P<0.05). * - P<0.05 for the difference in slope of change in risk factor between NHANES III-II vs. NHANES 1999-2004/III. Definitions: Hypertension: participants with a systolic blood pressure ≥140 or diastolic blood pressure ≥90mmHg Diabetes: participants with self-reported diabetes and/or a fasting glucose level ≥126mg/dL Obesity: participants with a body mass index ≥30kg/m2 High Cholesterol: participants with a total cholesterol ≥240 Smoker: participants currently smoking cigarettes, cigars, or pipes
Figure 2
Figure 2. Overall Trends in Cardiovascular Risk Factors – Females
Represents the change in prevalence over the five common CV risk factors over time. Error bars represents risk score ± standard error of mean. The difference in prevalence of each individual risk factor between consecutive surveys and their overall trend are significant (P<0.05). * - P<0.05 for the difference in slope of change in risk factor between NHANES III-II vs. NHANES 1999-2004/III. Definitions: Hypertension: participants with a systolic blood pressure ≥140 or diastolic blood pressure ≥90mmHg Diabetes: participants with self-reported diabetes and/or a fasting glucose level ≥126mg/dL Obesity: participants with a body mass index ≥30kg/m2 High Cholesterol: participants with a total cholesterol ≥240 Smoker: participants currently smoking cigarettes, cigars, or pipes
Figure 3
Figure 3. Trend in Overall 10-year Cardiovascular Disease Risk
Represents the 10-year Cardiovascular Disease Risk as calculated by Wilson et al in the overall patient cohort. All risks are standardized according to the 2000 census of the United States. * - P<0.05 comparing the rate of slope or rate of change in Cardiovascular Disease Risk between NHANES III/ and NHANES II, or NHANES 1999-2004 and NHANES III. Abbreviations: CV – Cardiovascular; NHANES – National Health and Nutrition Examination Survey
Figure 4
Figure 4. Trend in Cardiovascular Disease Risk by Sex
Represents the 10-year Cardiovascular Disease Risk as calculated by Wilson et al in the both males and females. All risks are standardized according to the 2000 census of the United States. Error bars represents risk score ± standard error of mean * - P<0.05 comparing the rate of slope or rate of change in Cardiovascular Disease Risk between NHANES III and NHANES II, or NHANES 1999-2004 and NHANES III. Abbreviations: CV – Cardiovascular; NHANES – National Health and Nutrition Examination Survey
Figure 5
Figure 5. Trend in Cardiovascular Risk by Age
Represents the 10-year Cardiovascular Disease Risk as calculated by Wilson et al. All risks are standardized according to the 2000 census of the United States. Error bars represents risk score ± standard error of mean * - P<0.05 comparing the rate of slope or rate of change in Coronary Heart Disease risk between NHANES III and NHANES II, or NHANES 1999-2004 and NHANES III
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