Trends in Cardiovascular Risk in the United States 1999 - 2018

Introduction: As guidelines evolve, lifestyle changes and new drugs are introduced, the long-term trends in cardiovascular risk in the general population are of interest. We evaluated the AHA-ACC-ASCVD risk score (ASCVD-RS) in the US population in the last 20 years. Methods: Participants in the National Health and Nutrition Examination Survey (NHANES) 1999–2018 aged 40–79 years were included. Pregnant participants and those with missing relevant laboratory/self-reported data were excluded. Temporal trends in ASCVD-RS and its components, and the proportions of participants at high risk (score ≥10%) were characterized using linear regression, adjusted for age, sex, and ethnicity. Data analysis was performed using the R statistical package “survey” (version 3.6.3). Results: Altogether 12744 NHANES participants (mean age 56.4 years; 55.9% male) were analyzed. From 1999–2018, the proportion of people with diabetes and taking antihypertensives increased significantly (both p<0.001), while total cholesterol level decreased significantly (p<0.001). Levels of high-density lipoprotein-cholesterol (HDL), and the proportion of smokers and individuals with systolic blood pressure ≥120mmHg remained static. The mean ± standard error of ASCVD-RS significantly increased from 11.4±0.7% in 1999–2000 to 12.5±0.5% in 2017–2018 (p=0.014), and the proportion of high-risk participants increased from 39.1% to 44.1% (p=0.020). Conclusions: Cardiovascular risk in the US population increased slightly in the past 20 years. Despite the increased treatment rate of hypertension and the decrease in total cholesterol, the prevalence of diabetes doubled. More effort should be directed at preventing diabetes through weight control and regular physical activity.