Risk factors in adults with cardiovascular disease are worsening over time

July 15, 2022
Study shows that CVD risk factors are not improving.

In an analysis of medical information of more than 6,000 American adults with a history of cardiovascular disease (CVD), researchers at Johns Hopkins Medicine conclude that CVD risk “profiles” in secondary prevention have failed to improve over the last two decades.

Secondary prevention refers to prevention of recurrent cardiovascular events such as heart attack or stroke in individuals who already have CVD. Despite recent advancements in safe and effective therapies reflected in guideline recommendations, trends in CVD risk profiles in adults with the condition were not ideal from 1999 through 2018. An ideal risk profile is based on targets that health professionals agree to be considered desirable. The study was published July 4 in the Journal of the American College of Cardiology.

Risk-factor profiles analyzed included blood glucose, blood pressure, cholesterol, body mass index, smoking, physical activity and diet. All factors showed a worsening or unchanged trend, except for cholesterol, which showed a modest improvement. However, only 30% of adults with CVD had an ideal cholesterol profile in 2015–2018.

The study also revealed persistent racial and ethnic disparities in heart-related health.

Researchers evaluated trends in cardiovascular risk factor profiles among 6,335 U.S. adults from data gathered by the National Health and Nutrition Examination Survey from 1999–2018. About 50% of participants were male, with an average age of 64.5, and 13% of them were Black, 10% were Hispanic and 3% were Asian.

Specifically, the new analysis showed:

  • Blood glucose ideal profile trends fell from 59% in 1999–2002 to 52% in 2015–2018, with the worst profiles found among Asian adults.
  • Blood pressure ideal levels fell after 2010, with 49% having an ideal profile in 2015–2018, with the worst profiles found among Black adults.
  • Cholesterol ideal profiles showed an overall increase from 7% in 1999–2002 to 30% in 2015–2018 — likely due to widespread use of lipid lowering medications — but with a worsening trend among Hispanic adults.
  • Body mass index (BMI), a measure of overweight, saw an overall worsening ideal profile from 24% in 1999–2002 to 18% in 2015–2018.
  • Smoking, physical activity and dietary profiles showed no significant changes over time overall, but the analysis found worsening smoking trend among Black adults, and improving trend for physical activity among Hispanic adults.

Johns Hopkins release

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