AI Insight
This analysis of over 60,000 US adults from 1999-2023 reveals mixed trends in cardiovascular health. While smoking rates, blood pressure, and cholesterol levels improved significantly over this period, obesity increased from 47% to 57% and diabetes rose from 8% to 12%. Notably, blood pressure control peaked in 2013-2014 at 33% before declining to 22% by 2021-2023, and predicted heart failure risk increased even as atherosclerotic cardiovascular disease risk slightly decreased.
Why it matters
These findings indicate that despite improvements in some traditional risk factors, the rising prevalence of obesity and diabetes, combined with declining blood pressure control rates, may be driving an increased risk of heart failure in the US population. The divergence between atherosclerotic disease and heart failure risk trajectories suggests different prevention strategies may be needed for these conditions.
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⚠️ Preprint – Noch nicht peer-reviewed
Dieser Artikel wurde noch nicht von unabhängigen Experten begutachtet. Die Ergebnisse sind vorläufig und sollten mit Vorsicht interpretiert werden.
Background: Cardiovascular risk factors have changed in the United States, but trends in prevalence, management, and predicted risk through the post-pandemic period remain incompletely characterized. Methods: We analyzed 11 National Health and Nutrition Examination Survey (NHANES) periods (1999-2000 through 2021-2023) among 60,199 nonpregnant adults aged 20 years. Survey-weighted regression assessed age-standardized trends, subgroup differences, and measurement-change sensitivity. We assessed awareness, treatment, and control of hypertension, dyslipidemia, and diabetes. PREVENT equations estimated 10- and 30-year risks among adults without self-reported cardiovascular disease (CVD). Results: Obesity increased from 47.4% to 57.2% (odds ratio [OR] per decade, 1.23; 95% CI, 1.16-1.30), with class III obesity more than doubling (4.7% to 9.7%). Diabetes increased from 8.2% to 12.7% (OR, 1.26; 95% CI, 1.19-1.34), while current smoking declined from 24.4% to 14.9% (OR, 0.76; 95% CI, 0.71-0.81). Hypertension, dyslipidemia, chronic kidney disease, and prior CVD showed no significant linear trends, although mean systolic blood pressure (BP) (124.2 to 120.2 mm Hg) and total cholesterol (203.6 to 188.1 mg/dL) declined, alongside improvements in other lipids. Hypertension and dyslipidemia awareness and treatment increased, but BP control peaked at 32.5% in 2013-2014 before declining to 21.5%, while LDL cholesterol control rose from 17.0% to 34.2%. Diabetes awareness increased, but treatment trends were nonsignificant. Glycemic control peaked at 51.2% in 2003-2004 before declining to 41.9% (P for nonlinearity <0.001). Predicted 10-year total CVD risk declined from 5.66% to 5.28%; atherosclerotic CVD (ASCVD) risk declined by 0.16 percentage points per decade (95% CI, 0.22 to 0.09), while heart failure (HF) risk increased by 0.10 (95% CI, 0.03-0.17). Their 2021-2023 estimates were nearly identical (3.20% and 3.19%, respectively); 30-year risks showed similar divergence. Conclusions: Improvements in smoking, blood pressure, and lipids coexisted with rising obesity and diabetes, declining blood pressure control after earlier gains, and divergent predicted ASCVD and HF risks.