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. 2022 Jul 12;80(2):126-137.
doi: 10.1016/j.jacc.2022.04.047.

Secular Trends in Risk Profiles Among Adults With Cardiovascular Disease in the United States

Yumin Gao  1 , Nino Isakadze  1 , Eamon Duffy  2 , Qicong Sheng  1 , Jie Ding  1 , Zane T MacFarlane  1 , Yingying Sang  3 , Scott T McClure  4 , Elizabeth Selvin  3 , Kunihiro Matsushita  3 , Seth S Martin  5
Affiliations

Secular Trends in Risk Profiles Among Adults With Cardiovascular Disease in the United States

Yumin Gao et al. J Am Coll Cardiol. .

Abstract

Background: Documenting trends in risk factors among individuals with cardiovascular disease (CVD) may inform policy and secondary prevention initiatives.

Objectives: This study aimed to examine 20-year trends in risk profiles among U.S. adults with CVD and any racial/ethnic disparities.

Methods: In this serial cross-sectional analysis of 6,335 adults with self-reported CVD participating in the National Health and Nutrition Examination Survey from 1999 through 2018, we calculated age- and sex-adjusted proportions with ideal risk factor attainment.

Results: The proportions with ideal hemoglobin A1c (<7% if diabetes or <5.7% if not) and body mass index (<25 kg/m2) worsened from 58.7% (95% CI: 55.2%-62.1%) to 52.4% (95% CI: 48.2%-56.6%) and 23.9% (95% CI: 21.5%-26.4%) to 18.2% (95% CI: 15.6%-21.2%) from 1999-2002 to 2015-2018, respectively. After initial improvement, the proportion with blood pressure <130/80 mm Hg declined from 52.1% (95% CI: 48.9%-55.4%) in 2007-2010 to 48.6% (95% CI: 44.2%-52.7%) in 2015-2018. The proportion with non-high-density lipoprotein cholesterol levels <100 mg/dL increased from 7.3% (95% CI: 5.6%-9.5%) in 1999-2002 to 30.3% (95% CI: 25.7%-35.5%) in 2015-2018. The proportions with ideal smoking, physical activity, and diet profiles were unchanged over time, and in 2015-2018 were 77.8% (95% CI: 73.6%-81.4%), 22.4% (95% CI: 19.3%-25.9%), and 1.3% (95% CI: 0.7%-2.6%). Worsening trends were observed in Hispanic adults for cholesterol, and in Black adults for smoking (both P < 0.05 for nonlinear and linear trends). Persistently lower ideal risk factor attainment was observed for blood pressure in Black adults and for hemoglobin A1c levels in Asian adults compared with White adults (all P < 0.05 for differences).

Conclusions: Trends in cardiovascular risk factor profiles in U.S. adults with CVD were suboptimal from 1999 through 2018, with persistent racial/ethnic disparities.

Keywords: U.S. trends; cardiovascular disease; health equity; risk factor profiles; secondary prevention.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Martin is a founder of and holds equity in Corrie Health; has received material support from Apple and iHealth; has received funding from the Maryland Innovation Initiative, Wallace H. Coulter Translational Research Partnership, Louis B. Thalheimer Fund, the Johns Hopkins Individualized Health Initiative, the American Heart Association (20SFRN35380046, 20SFRN35490003, COVID19-811000, #878924, and #882415), the Patient-Centered Outcomes Research Institute (ME-2019C1-15328), the National Institutes of Health (P01 HL108800 and R01AG071032), the David and June Trone Family Foundation, the Pollin Digital Innovation Fund, the PJ Schafer Cardiovascular Research Fund, Sandra and Larry Small, CASCADE FH, Google, and Amgen; has received personal fees for serving on scientific advisory boards for Amgen, AstraZeneca, Dalcor, Esperion, Kaneka, Novartis, Novo Nordisk, Sanofi, and 89bio; and is a coinventor on a system for low-density lipoprotein cholesterol estimation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

FIGURE 1
FIGURE 1. Cardiovascular Risk Profiles Among U.S. Adults With CVD, NHANES 1999-2018
Poor (black), intermediate (red), and ideal (blue) levels of cardiovascular risk profiles are defined in Supplemental Table 3. All estimates were adjusted for age and sex. (A) HbA1c, (B) blood pressure, (C) non-HDL-C, (D) body mass index, (E) smoking, (F) physical activity, and (G) diet. CVD = cardiovascular disease; HbA1c = hemoglobin A1c; NHANES = National Health and Nutrition Examination Survey; non–HDL-C = non-high-density lipoprotein cholesterol.
FIGURE 1
FIGURE 1. Cardiovascular Risk Profiles Among U.S. Adults With CVD, NHANES 1999-2018
Poor (black), intermediate (red), and ideal (blue) levels of cardiovascular risk profiles are defined in Supplemental Table 3. All estimates were adjusted for age and sex. (A) HbA1c, (B) blood pressure, (C) non-HDL-C, (D) body mass index, (E) smoking, (F) physical activity, and (G) diet. CVD = cardiovascular disease; HbA1c = hemoglobin A1c; NHANES = National Health and Nutrition Examination Survey; non–HDL-C = non-high-density lipoprotein cholesterol.
FIGURE 2
FIGURE 2. Trends in Ideal Risk Profiles According to Race/Ethnicity, NHANES 1999-2018
All estimates were adjusted for age and sex. Trends in non–HDL-C <100 mg/dL (P = 0.003 and P = 0.002 for nonlinear trend in White and Hispanic adults, respectively; P < 0.001 for linear trend in Black adults); never smoked or quit smoking >1 year (P = 0.22, P = 0.049, and P = 0.28 for linear trend in White, Black, and Hispanic adults); and physical activity (P = 0.17, P = 0.55, and P = 0.008 for linear trend White, Black, and Hispanic adults). (A) HbA1c, (B) blood pressure, (C) non-HDL-C, (D) body mass index, (E) smoking, (F) physical activity, and (G) diet. Error bars indicate 95% CIs. Abbreviations as in Figure 1.
FIGURE 2
FIGURE 2. Trends in Ideal Risk Profiles According to Race/Ethnicity, NHANES 1999-2018
All estimates were adjusted for age and sex. Trends in non–HDL-C <100 mg/dL (P = 0.003 and P = 0.002 for nonlinear trend in White and Hispanic adults, respectively; P < 0.001 for linear trend in Black adults); never smoked or quit smoking >1 year (P = 0.22, P = 0.049, and P = 0.28 for linear trend in White, Black, and Hispanic adults); and physical activity (P = 0.17, P = 0.55, and P = 0.008 for linear trend White, Black, and Hispanic adults). (A) HbA1c, (B) blood pressure, (C) non-HDL-C, (D) body mass index, (E) smoking, (F) physical activity, and (G) diet. Error bars indicate 95% CIs. Abbreviations as in Figure 1.
FIGURE 3
FIGURE 3. Trends in Mean Secondary Prevention Metric, NHANES 1999-2018
(A) Overall and (B) by race and ethnicity. All estimates were adjusted for age and sex. Error bars indicate 95% confidence intervals. Abbreviations as in Figure 1.
CENTRAL ILLUSTRATION
CENTRAL ILLUSTRATION. Trends in Risk Profiles in U.S. Adults With Cardiovascular Disease, 1999 to 2018
Each light blue box summarizes the overall trend, proportion with an ideal risk profile in 2015-2018, and any racial/ethnic disparities for the following individual risk factors: hemoglobin A1c, blood pressure, non–high-density lipoprotein cholesterol, body mass index, smoking control, self-reported moderate or vigorous physical activity, and diet. All estimates were adjusted for age and sex and accounted for the sampling design of the National Health and Nutrition Examination Survey. HbA1c = hemoglobin A1c; HEI = Healthy Eating Index; non-HDL-C = non-high-density lipoprotein cholesterol.
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