Trends in cardiovascular disease risk factors by obesity level in adults in the United States, NHANES 1999-2010

Abstract

Objective: To assess whether trends in cardiovascular disease (CVD) risk factors by among overweight and obese US adults have improved.

Methods: The study included 10,568 adults 18 years and older who participated in National Health and Nutrition Examination Survey 1999-2010. CVD risk factors included diabetes (self-reported diagnosis, glycated hemoglobin ≥6.5%, or fasting plasma glucose ≥126mg/dl), hypertension (treatment or blood pressure ≥140/90 mmHg), dyslipidemia (treatment or non-HDL cholesterol ≥160 mg/dl), and smoking (self-report or cotinine levels ≥10 ng/ml). The prevalence and temporal trends of CVD risk factors for each BMI group were estimated.

Results: In 2007-2010, the prevalence of diabetes, hypertension, and dyslipidemia was highest among obese (18.5%, 35.7%, 49.7%, respectively) followed by overweight (8.2%, 26.4%, 44.2%, respectively) and normal weight adults (5.4%, 19.8%, 28.6%, respectively). Smoking exposure was highest among normal weight (29.8%) followed by overweight (24.8%) and obese adults (24.6%). From 1999-2002 to 2007-2010, untreated hypertension decreased among obese and overweight adults and untreated dyslipidemia decreased for all weight groups. There were no significant temporal changes in smoking across BMI groups.

Conclusions: Despite decreases in untreated risk factors, it is important to improve the CVD risk profile of overweight and obese US adults.

Keywords: NHANES; adults; cardiovascular disease risk factors; diabetes; dyslipidemia; hypertension; obesity.

Figure 1

Proportion (age standardized to the 2000 US population using the following age groups: 18-44, 45-64, and ≥65 years) of undiagnosed or untreated among total cardiovascular disease risk group overall and by body mass index group among adults 18 years and older, National Health and Nutrition Examination Surveys 1999 to 2010. *Estimates for normal weight participants not presented due to small sample size (<150) and relative standard error <35%. Normal weight = BM 18.5 to <25 kg/m²; overweight = BMI 25 to <30 kg/m²; obese = BMI ≥ 30 kg/m²; morbidly obese = BMI ≥ 35 kg/m Proportion of undiagnosed diabetes among adults with total diabetes fasting in morning exam. Proportion of untreated hypertension among adults with total hypertension. Proportion of untreated dyslipidemia among adults with total dyslipidemia. Total diabetes = self-report of diagnosis by health care professional or A1c level ≥ 6.5% or fasting plasma glucose ≥ 126 mg/dl Undiagnosed diabetes = no self-report and A1c level ≥ 6.5% or fasting plasma glucose ≥ 126 mg/dl. Total hypertension = self-report of antihypertensive medications or blood pressure ≥ 140/90 mmHg; Untreated hypertension = no self-report of antihypertensive medications and blood pressure ≥ 140/90 mmHg. Total dyslipidemia = self-report of medications to lower cholesterol or non-HDL cholesterol ≥ 160 mg/dl; Untreated dyslipidemia = no report of cholesterol lowering medications and non-HDL cholesterol ≥ 160 mg/dl.