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Trends in CVD risk factor burden reversing in recent decades
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New findings suggest that the percentage of Americans with a low risk factor burden for CVD is currently lower than 10%.
Researchers used data from four installments of the National Health and Nutrition Examination Survey (NHANES) I, II, III and NHANES from 1999 to 2004 and developed an index of low risk burden using several variables. The criteria included not currently smoking, total cholesterol <5.17 mmol/L without taking cholesterol-lowering medications, systolic BP <120 mm Hg and diastolic BP <80 mm Hg without antihypertensive medications, BMI <5 kg/m2 and no previous diagnosis of diabetes.
According to the study results, the age-adjusted prevalence of low risk factor burden increased from 4.4% in the NHANES I population (participants from 1971 to 1975) to 10.5% the NHANES III population (from 1988 to 1994), followed by a decrease to 7.5% in the NHANES 1999 to 2004 population (P<.001 for nonlinear trend). The researchers reported that patterns were similar between men and women, although women had a higher prevalence of low risk factor burden consistently across all surveys (P<.001 for each survey period). Whites had a higher prevalence of low risk factor burden when compared with Mexican Americans surveyed between 1988 to 1994 (P<.001) and 1999 to 2004 (P=.001). Whites also tended to have higher prevalence of low risk factor burden vs. blacks (P<.001) for all periods except the period between 1976 and 1980 (P=.154).
“Our analysis suggests that achieving low risk status is a distant and challenging goal,” the researchers wrote in their conclusion. “Unfortunately, the limited strides that were made toward this goal during the 1970s and 1980s were eroded by the increases in excess weight, diabetes mellitus and hypertension during more recent decades.”
In an accompanying editorial, Rob M. van Dam, PhD, an assistant professor of medicine at Harvard Medical School in Boston, and Walter C. Willett, MD, PhD, a professor of epidemiology and nutrition at the Harvard School of Public Health, noted that the trends continued to worsen in recent decades despite advances in medical technology and drugs.
“The findings of Ford et al provide an important signal that American health is at a crossroad,” they wrote. “The current path leads to increasing adiposity, diabetes, CVD and disability and an unfit, socially isolated population stuffed with pills and subjected to frequent palliative procedures. […] An alternative scenario is possible if we take every opportunity to support optimal nutrition and physical activities of our children and to create an environment that encourages healthy options throughout life.”
Ford E. Circulation. 2009doi:10.1161/CIRCULATIONAHA.108.835728.