Study draws attention to poor rates of cardiometabolic health among US adults

New research from an analysis of trends in the cardiovascular health of US adults from 1999-2018 highlights alarming trends in cardiometabolic health across the nation.

Using a nationally representative sample of about 55,000 adults aged 20 and older from the 10 most recent cycles of the National Health and Nutrition Examination Survey (NHANES), researchers found that only 75 of US adults had optimal levels of cardiometabolic health as of 2017-2018 and also sheds light on other trends, including increased prevalence of diabetes or pre-diabetes and obesity.

“These numbers are staggering. It is deeply problematic that in the United States, one of the wealthiest nations in the world, fewer than 1 in 15 adults have optimal cardiometabolic health,” said lead researcher Megan O’Hearn, MS, a doctoral student in the School of Nutrition at Friedman and Politics at Tufts University, in a statement. “We need a complete overhaul of our health system, food system and built environment because this is a crisis for everyone, not just one section of the population.”

Initiated with the intent to examine trends in cardiometabolic health among US adults, the current study was designed to analyze data from 55,081 adults who participated in the 1999-2018 NHANES cycles. Researchers defined optimal cardiometabolic health based on on scores of adiposity, blood glucose, blood lipids, blood pressure, and absence of clinical cardiovascular disease, with researchers assigning optimal, intermediate, and poor scores for each of the 5 components.

Optimal obesity was defined as a BMI below 25 kg/m2 and a waist circumference of 88 cm or less in women and 102 cm or less in men. Optimal blood glucose is defined as fasting plasma glucose below 100 mg/dL and HbA1c above 5.7% while not taking diabetes medications. Optimal blood lipids were defined as a ratio of total cholesterol to high-density lipoprotein less than 3.5:1 and no lipid-lowering medication. Optimal blood pressure is defined as a systolic blood pressure below 120 mmHg and a diastolic blood pressure below 80 mmHg without the presence of blood pressure-lowering drugs. An optimal history of cardiovascular disease was defined as the absence of angina pectoris, coronary heart disease, myocardial infarction, heart failure, and stroke. As part of the study, the researchers planned multiple subgroup analyses, including those stratified by age, sex, race/ethnicity, education level, and income.

Assessing sociodemographic trends from 1999-2018 within the NHANES data, the researchers found that the proportion of duelists over the age of 65 increased from 15.8% in the 1999-2000 cycle to 20. 4% in the 2017-2018 cycle. Conversely, the share of people aged 20-34 fell from 31.8% in the 1999-2000 survey cycle to 27.6% in the 2017-2018 cycle. The researchers also thus indicated that the share of non-Hispanic white adults decreased from 70.3% to 62.2% from the 1999-2000 survey cycle to the 2017-2018 cycle, while those identifying as other races, which include Asian and those identifying as multiracial increased from 4.4% to 10.5%.

After analysis, the researchers found that only 6.8% (95% CI, 5.4-8.1%) of US adults had optimal cardiometabolic health in the 2017-2018 survey cycle, with the median number of optimal levels of The 5-factor decreased from 2.5 (95% CI, 2.4-2.6) in the 1999-2000 study cycle to 2.2 (95% CI, 2.1-2.3) in 2017 -2018 In subgroup analyses, outcomes promoting optimal cardiometabolic health were less likely among adults aged 65 years and older (0.4% [95% CI, 0.0-1.0%]) compared to those aged 20-34 (15.3% [95% CI, 11.6-19.1%]) and among men (3.1% [95% CI, 1.9-4.4%]) compared to women (10.4% [95% CI, 8.2-12.6%]).

When assessing changes in individual components of cardiometabolic health, the greatest declines were seen in obesity (optimal levels: 33.8%-24.0%; poor levels: 47.7%-61.9%) and glucose (optimal levels: 59.4%-36.9%; poor levels: 8.6-13.7%) (P <.001 for each). In the 2017-2018 survey cycle, the prevalence of optimal cardiometabolic health was lower among US adults with a lower (5.0% [95% CI, 2.8%-7.2%]) educational achievements compared to higher education (10.3% [95% CI, 7.6-13.0%]) and among Mexican Americans (3.2% [95% CI, 1.4-4.9%]) compared to non-Hispanic whites (8.4% [95% CI, 6.3-10.4%]) adults.

“This is really problematic. “Social determinants of health such as food and nutrition security, social and community context, economic stability, and structural racism place individuals of various educational levels, races, and ethnicities at increased risk for health problems,” said senior researcher Dariush Mozaffarian, MD, DrPH, dean of the Friedman School, in the aforementioned statement. “This highlights the other important work being done at the Friedman School and Tufts University to better understand and address the root causes of nutrition and health disparities in the US and around the world.”

This study, “Trends and disparities in cardiometabolic health among US adults, 1999-2018,” was published in Journal of the American College of Cardiology.

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