Is Prevalence of Atherosclerotic Risk Factors Increasing Among Young Adults? It Depends on How You Ask

BACKGROUND: Incidence of cardiovascular disease in young adults is unabated. Increased prevalence of self‐reported atherosclerotic risk factors may be driving this trend. The goal of this study was to examine whether the prevalence of atherosclerotic risk factors in young adults is increasing over time using both self‐report and standard clinical criteria. METHODS AND RESULTS: Data from young adults, aged 20 to 45 years, in the National Health and Nutrition Examination Survey from 1999/2000 to 2013/2014 were analyzed. Risk factor prevalence of hypertension, diabetes mellitus, and hyperlipidemia was measured using clinical criteria and self‐report. Smoking was based on self‐report only, and obesity was based clinically on body mass index and waist to height ratio. Prevalence by survey was adjusted for age, sex, and race/ethnicity. By clinical criteria, adjusted prevalence of any 3 risk factors (hypertension, diabetes mellitus, and hyperlipidemia) declined slightly from 21.8% to 18.9% (P for trend=0.05). However, by self‐report, the adjusted prevalence of any 3 risk factors increased from 17.8% to 26.5% (P<0.01). Hypertension was unchanged by clinical criteria (P=0.32) but increased by self‐report (P<0.08). Diabetes mellitus, by clinical diagnosis and self‐report, remained unchanged (P=0.35 and P=0.29, respectively). Hyperlipidemia, by clinical criteria, declined over time (P<0.01), but increased by self‐report (P<0.01). Smoking declined (P<0.01), and obesity increased by both body mass index (P<0.01) and waist/height ratio (P<0.01). CONCLUSIONS: The perception that young adult risk factors are increasing is consistent with increasing self‐reported risk factors. However, evidence does not suggest that clinical risk factor prevalence overall has increased in young adults.