Declines in US cardiometabolic health ‘striking’; disparities persist over 2 decades
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The prevalence of optimal cardiometabolic health among U.S. adults declined in the past 2 decades, with disparity gaps widening based on age, sex, education and race, researchers reported.
Optimal cardiometabolic health was defined as optimal levels of adiposity, blood glucose, blood lipids and BP, as well as no history of clinical CVD, according to data published in the Journal of the American College of Cardiology.
“In 2017-2018, only 6.8% American adults had good cardiometabolic health — a decline from 7.7%, an already concerningly low figure, in 1999-2000 — with disparities by age, sex, education level and race and ethnicity,” Meghan K. O’Hearn, MS, doctoral candidate in the Friedman School of Nutrition Science and Policy at Tufts University, told Healio. “Diet is one of the primary contributors to unhealthy weight gain and poor blood glucose levels, and diet quality in the U.S. is poor, and worsening. So, while these findings were not necessarily surprising, they confirmed that there is a pressing need to reverse this trend.”
To better understand trends in U.S. cardiometabolic health, researchers utilized the National Health and Nutrition Examination Survey to evaluate optimal levels of adiposity, blood glucose, blood lipids, BP and clinical CVD among more than 55,000 adults.
Defining optimal cardiometabolic health
Optimal levels of each of the five components of cardiometabolic health were as follows:
- adiposity: BMI < 25 kg/m2, waist circumference < 88 cm for women and < 102 cm for men;
- blood glucose: fasting glucose < 100 mg/dL, HbA1c < 5.7% and not taking diabetes medication;
- blood lipids: total cholesterol to HDL ratio < 3.5:1 and not on lipid-lowering therapy;
- BP: systolic BP < 120, diastolic BP < 80 and not on BP-lowering therapy; and
- clinical CVD: no history of CHD, MI, HF or stroke.
In 2017-2018, 6.8% (95% CI, 5.4-8.1) of adults included in the analysis had optimal cardiometabolic health, defined as optimal levels of all five components lists, and declined from the 1999-2000 period (P for trend = .02).
In 1999-2000, the mean number of optimal cardiometabolic factors was 2.5 of five (95% CI, 2.4-2.6), which decreased to a mean of 2.2 of five in the 2017-2018 period (95% CI, 2.1-2.3).
The mean number of poor levels of each cardiometabolic factor did not change significantly.
“These numbers are striking. It’s deeply problematic that in the United States, one of the wealthiest nations in the world, fewer than 1 in 15 adults have optimal cardiometabolic health,” O’Hearn said in a press release issued by Tufts University. “We need a complete overhaul of our health care system, food system and built environment, because this is a crisis for everyone, not just one segment of the population.”
In 2017-2018, optimal cardiometabolic health was less common among adults aged 65 years or older compared with those aged 20 to 34 years (0.4% vs. 15.3%) and less common among men compared with women (3.1% vs. 10.4%), according to the study.
Within the individual components of cardiometabolic health, the largest declines in optimal level were observed in adiposity, declining from 33.8% to 24%, and glucose, declining from 59.4% to 36.9% (P for trend for each < .001).
Optimal levels of blood lipids increased from 29.9% to 37% and poor levels of blood lipids decreased from 28.3% to 14.7% (P for trend < .001).
Disparities in optimal cardiometabolic health
Researchers reported that changes over time for BP and clinical CVD were small.
Moreover, researchers observed that disparities in optimal cardiometabolic health in 1999-2000 persisted and worsened based on age, sex, education and race/ethnicity.
“This is really problematic. Social determinants of health such as food and nutrition security, social and community context, economic stability and structural racism put individuals of different education levels, races and ethnicities at an increased risk of health issues,” Dariush Mozaffarian, MD, MPH, DrPH, cardiologist and dean of the Friedman School of Nutrition Science and Policy, said in the release.
In 2017-2018, the prevalence of optimal cardiometabolic health was lower among Americans with lower education compared with higher education (5% vs. 10.3%), and among Mexican adults in the U.S. compared with white adults (3.2% vs. 8.4%).
“The lack of good health and well-being can be addressed. Our findings support the growing body of evidence pointing to the need for targeted clinical and public health strategies to improve the health of the population. This includes Food is Medicine interventions; incentives and subsidies to make healthy food more affordable; consumer education on a healthy diet; and private sector engagement to drive a healthier and more equitable food system,” O’Hearn told Healio. “While we need accelerated research efforts to understand the underlying causes of these conditions, drivers of health disparities, and the effectiveness of public health interventions and policies, we know that we can, and must, have a healthier and more equitable food system.”
For more information:
Meghan K. O'Hearn, MS, can be reached at meghan.o_hearn@tufts.edu.
Reference:
- Only seven percent of adults have good cardiometabolic health. https://www.eurekalert.org/news-releases/957255. Published July 4, 2022. Accessed July 5, 2022.
Perspective
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Leslie Cho, MD
This is an important study but not surprising given the increasing obesity epidemic in America. Sadly, the trend of increasing obesity, which then leads to all the other increases in CVD risk, is to be expected. We also know that income, education and social determinants of health play a major role in patients’ overall health. We also lead busier lives and even the higher-income and more-educated portions of the population are not doing as well as we would like.
This is more than just personal will. This requires societal effort. The fact that some of our patients live in a food desert as well as living in neighborhoods that are not walkable has huge implications for cardiac health. Also, it is cheaper to buy “unhealthy” food compared with healthy food. We need to make it easier for patients to make correct choices. Healthier food should be cheaper and easier to obtain. Our cities and lives should be designed to make us more active.
This impacts everyone. Having a portion of population that is unhealthy affects us all.
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