Risk Management

CVD Risk Factors in Adults Are Worsening Over Time

Risk factors in individuals with cardiovascular disease (CVD) in the United States have worsened over time with persistent racial/ethnic disparities, despite advances in secondary prevention recommendations.

The researchers aimed to document trends in CVD risk factors to help inform policy and secondary interventions. They examined 20-year trends in risk profiles among US adults with CVD, documenting any racial/ethnic disparities.

The researchers conducted a serial cross-sectional analysis of 6335 adults with self-reported CVD. All individuals in the study participated in the National Health and Nutrition Examination Survey from 1999 through 2018. Using the data, the researchers calculated age- and sex-adjusted proportions with ideal risk factor attainment.

Risk factors for ideal hemoglobin A1c, blood pressure, and cholesterol levels were included. Ideal hemoglobin A1C was defined here as less than 7% in individuals with diabetes or less than 5% in individuals without diabetes, and a BMI of less than 25 kg/m2. Blood pressure was measured as less than 130/80 mm Hg, and non-high density lipoprotein cholesterol levels were measured as less than 100 mg/dL.

After their analysis, the authors reported the following:

  • Proportions with ideal hemoglobin A1c worsened from 58.7% (95% CI; 55.2% - 62.1%) to 52.4% (95% CI; 48.2% - 56.6%) from 1999 to 2002, and 23.9% (95% CI; 21.5% - 26.4%) to 18.2% (95% CI: 15.6%-21.2%) from 2015 to 2018.
  • Even after initial improvement, the proportion of patients with ideal blood pressure fell from 52.1% (95% CI; 48.9% - 55.4%) in 2007 to 2010, to 48.6% (95% CI; 44.2% - 52.7%) in 2015 to 2018.
  • Proportions with ideal cholesterol levels increased from 7.3% (95% CI; 5.6% - 9.5%) in 1999 to 2002 to 30.3% (95% CI; 25.7% - 35.5%) in 2015 to 2018.
  • Ideal smoking, physical activity, and diet profiles proportions were unchanged over time. In 2015 to 2018 they were 77.8% (95% CI; 73.6% - 81.4%), 22.4% (95% CI; 19.3% 25.9%), and 1.3% (95% CI; 0.7% - 2.6%), respectively.

Additionally, in adults who are Hispanic, worsening trends were observed for cholesterol data. For adults who are Black, worsening trends occurred for smoking. When compared with adults who are White, lower ideal risks were noted for adults who are Black and lower hemoglobin A1c levels in adults who are Asian.

We observed persistently suboptimal cardiovascular risk factor profiles among U.S. adults with CVD from 1999 through 2018,” the authors concluded. “These data highlight a major gap in translating secondary prevention guideline recommendations into practice…These findings serve as an urgent call for innovative and comprehensive solutions to improve.”


—Jessica Ganga


Gao Y, Isakadze N, Duffy E, et al. Secular trends in risk profiles among adults with cardiovascular disease in the United States. J Am Coll Cardiol. Published online July 04, 2022. doi:10.1016/j.jacc.2022.04.047