Trends in prevalence, risk factor control and medications in atherosclerotic cardiovascular disease among US Adults, 1999-2018

Abstract

Objectives: Trends in prevalence and treatments of atherosclerotic cardiovascular disease (ASCVD) remains to be documented, with frequent update of relevant guidelines. We aimed to characterize trends in prevalence of ASCVD, and risk factor control and medications among ASCVD adults.

Methods: We conducted a cross-sectional analysis of data from 55,081 adults in the National Health and Nutrition Examination Surveys (NHANES) 1999-2018.

Results: The age-standardized prevalence of ASCVD did not change significantly from 1999-2002 (7.9 %, 95 % CI 7.1 %-8.7 %) to 2015-2018 (7.5 %, CI 6.8 %-8.3 %) (P for trend =0.18), representing an estimated 19.9 million individuals with ASCVD in 2015-2018. The prevalence of premature ASCVD was 2.0 % (CI, 1.6 %-2.5 %). Over 60.0 % of ASCVD participants were at very-high risk. From 1999-2002 to 2015-2018, the percentage with lipid control (non-high-density lipoprotein cholesterol <100 mg/dL) increased from 7.0 % (CI, 3.5 %-12.3 %) to 26.4 % (CI, 16.2 %-38.9 %). The percentage with blood-pressure control (<130/80 mmHg) increased from 51.2 % (CI, 41.0 %-61.3 %) in 1999-2002 to 57.2 % (CI, 48.4 %-65.6 %) in 2011-2014, but then declined to 52.8 % (CI, 44.4 %-81.3 %) in 2015-2018. The percentage with glycemic control (HbA1c <7.0 %) decreased from 95.0 % (CI, 90.2 %-97.9 %) to 84.0 % (CI, 75.9 %-90.3 %). The percentage who achieved all 3 targets was 18.6 % (CI, 8.2 %-33.8 %) in 2015-2018. The percentage of ASCVD participants who were taking statins increased from 1999-2002 to 2011-2014, but then leveled off. Approximately 60 % of individuals with ASCVD and less than 40 % of those with premature ASCVD were taking statins in 2015-2018. The utilization of blood-pressure-lowering drugs remained largely constant over time, whereas the use of glucose-lowering drugs increased.

Conclusions: Based on NHANES data from US adults, the estimated prevalence of ASCVD remained relatively stable between 1999 and 2018. Substantial undertreatment with stains was found in individuals with ASCVD, and the percentage achieving optimal lipid control was low.

Keywords: blood pressure; glucose; lipid; medications; prevalence.

Central Illustration. Prevalence of ASCVD, risk factor control and medications among US adults, 1999–2002 to 2015–2018. The age-standardized prevalence of ASCVD was 7.5 % in 2015–2018, with the prevalence of coronary heart disease (CHD) doubles that of stroke. Among ASCVD adults, 61.0 % were at very-high risk. Blood-pressure, lipid, and glycemic control was achieved in 52.8 %, 26.4 % and 84 % of participants respectively, and 18.6 % of ASCVD participants achieved control of all 3 risk factors in 2015–2018. Trends in medications among US adults with ASCVD and premature ASCVD, 1999–2002 to 2015–2018, showing a lower percentage of medications in participants with premature ASCVD.

Fig. 1

Trends in prevalence of ASCVD among US adults, 1999–2002 to 2015–2018. ASCVD, atherosclerotic cardiovascular disease; CHD, coronary heart disease.

Fig. 2

Trends in risk factor control among US adults with ASCVD, 1999–2002 to 2015–2018. ASCVD, atherosclerotic cardiovascular disease.

Fig. 3

Trends in medications among US adults with ASCVD, 1999–2002 to 2015–2018. (A) Lipid-lowering medications. (B) Blood-pressure-lowering medications. (C) Glucose-lowering medications. ASCVD, atherosclerotic cardiovascular disease.