The prevalence of a low-risk profile for cardiovascular disease among adults in the U.S. population has decreased in recent years, suggesting the “huge potential” for preventing cardiovascular disease is far from being realized.
Using data from four National Health and Nutrition Examination Surveys, Dr. Earl S. Ford, medical officer of the U.S. Public Health Service at the Centers for Disease Control and Prevention in Atlanta, and colleagues tracked cardiovascular risk data for U.S. adults aged 25–75 years and showed that the prevalence of a low-risk profile increased from 4.4% at the time of the first survey (1971–1975) to 10.5% by the third survey (1988–1994), but then decreased to 7.5% in the fourth survey (1999–2004).
The low-risk-factor profile included these variables: not currently smoking; total cholesterol less than 200 mg/dL without cholesterol-lowering medications; BP less than 120/80 mm Hg without antihypertensive medications; body mass index less than 25 kg/m
“The limited strides that were made toward achieving low-risk status during the 1970s and 1980s have more recently been negated by the obesity epidemic and increased rates of hypertension and diabetes,” Dr. Ford said in an interview. Now, “fewer than 10% of Americans are meeting the low-risk goals.”
An analysis of the individual risk categories showed favorable trends for not currently smoking (60% at the time of the first survey and 74% by the fourth survey) and low concentrations of total cholesterol (35% and 43%). For blood pressure, the low-risk percentage was higher for the period 1988–1994 than for the 1971–1975 period, but it decreased for the period 1999–2004.
Similarly, “the distribution of body mass index progressively deteriorated over time,” they reported, adding that the unfavorable trends “argue for vigorous population-based approaches to reverse the unhealthy shift in the distributions of blood pressure and body mass index and to sustain or accelerate the improvement in the distribution of total cholesterol.”
In an accompanying editorial, Rob M. van Dam, Ph.D., of the Harvard School of Public Health in Boston, and Dr. Walter C. Willett of Brigham and Women's Hospital in Boston, wrote that the trajectory of the risk factor trends is even more worrisome considering the analyses “do not yet reflect the effects of the current epidemic of childhood obesity, which causes an early onset of type 2 diabetes, hypertension, and dyslipidemia.”
The findings “provide an important signal that the health of Americans is at a crossroad. The current path leads toward increasing adiposity, diabetes mellitus, cardiovascular disease, and disability and an unfit, socially isolated population stuffed with pills and subjected to frequent palliative procedures.”
To change course, they stressed, physicians can help by working with their patients one on one but “their help is needed even more as leaders in the effort to reshape policies and our environment.” (Circulation 2009;120:1171–3).
The authors report having no financial disclosures related to this report.