Race/Ethnic and Sex Differences in the Association of Atherosclerotic Cardiovascular Disease Risk and Healthy Lifestyle Behaviors

BACKGROUND: Lifestyle behaviors influence atherosclerotic cardiovascular disease (ASCVD) risk. We examined race and sex differences in the association of ASCVD risk with obesity and lifestyle behaviors. METHODS AND RESULTS: We used multivariable logistic regression to examine the association of race/ethnicity and sex with obesity and lifestyle behaviors among 12 351 adults in the National Health and Nutrition Examination Surveys cycles 2005 to 2014. Ten‐year ASCVD risk was estimated using the 2013 American College of Cardiology/American Heart Association pooled cohort equations. Among overweight/obese subjects, whites were more likely to consider themselves overweight, to report a desire to weigh less, and to report a healthy diet, and physical activity. Despite higher body mass index and/or ASCVD risk, black women (adj odds ratio [OR] 0.8, 95% confidence interval [CI], 0.7–0.9) were less likely to attempt weight loss, and Hispanic women (OR 0.8, 95% CI 0.6–0.9) were less likely to report physical activity than white women. Black women (adj OR 0.6, 95% CI 0.5–0.7) were less likely than white women, and Hispanics (women adj OR 0. 6, 95% CI 0.5–0.7; men adj OR 0.7, 95% CI 0.6–0.9) were less likely than whites to report a healthy diet. Among those with ASCVD risk >7.5%, there were even greater disparities in the likelihood of healthy diet between black and Hispanic versus white women, and among Hispanic versus white men. CONCLUSIONS: Race/ethnic minorities are less likely to engage in healthy lifestyle behaviors despite higher body mass index and ASCVD risk. These findings underscore the need for culturally sensitive recommendations to improve cardiovascular outcomes in high‐risk populations, particularly minority women.