Cardiovascular Risk Factor Prevalence, Treatment, and Control in US Adults Aged 20 to 44 Years, 2009 to March 2020

Abstract

ImportanceDeclines in cardiovascular mortality have stagnated in the US over the past decade, in part related to worsening risk factor control in older adults. Little is known about how the prevalence, treatment, and control of cardiovascular risk factors have changed among young adults aged 20 to 44 years.ObjectiveTo determine if the prevalence of cardiovascular risk factors (hypertension, diabetes, hyperlipidemia, obesity, and tobacco use), treatment rates, and control changed among adults aged 20 to 44 years from 2009 through March 2020, overall and by sex and race and ethnicity.Design, Setting, and ParticipantsSerial cross-sectional analysis of adults aged 20 to 44 years in the US participating in the National Health and Nutrition Examination Survey (2009-2010 to 2017–March 2020).Main Outcomes and MeasuresNational trends in the prevalence of hypertension, diabetes, hyperlipidemia, obesity, and smoking history; treatment rates for hypertension and diabetes; and blood pressure and glycemic control in those receiving treatment.ResultsAmong 12 924 US adults aged 20 to 44 years (mean age, 31.8 years; 50.6% women), the prevalence of hypertension was 9.3% (95% CI, 8.1%-10.5%) in 2009-2010 and 11.5% (95% CI, 9.6%-13.4%) in 2017-2020. The prevalence of diabetes (from 3.0% [95% CI, 2.2%-3.7%] to 4.1% [95% CI, 3.5%-4.7%]) and obesity (from 32.7% [95% CI, 30.1%-35.3%] to 40.9% [95% CI, 37.5%-44.3%]) increased from 2009-2010 to 2017-2020, while the prevalence of hyperlipidemia decreased (from 40.5% [95% CI, 38.6%-42.3%] to 36.1% [95% CI, 33.5%-38.7%]). Black adults had high rates of hypertension across the study period (2009-2010: 16.2% [95% CI, 14.0%-18.4%]; 2017-2020: 20.1% [95% CI, 16.8%-23.3%]), and significant increases in hypertension were observed among Mexican American adults (from 6.5% [95% CI, 5.0%-8.0%] to 9.5% [95% CI, 7.3%-11.7%]) and other Hispanic adults (from 4.4% [95% CI, 2.1%-6.8%] to 10.5% [95% CI, 6.8%-14.3%]), while Mexican American adults had a significant rise in diabetes (from 4.3% [95% CI, 2.3%-6.2%] to 7.5% [95% CI, 5.4%-9.6%]). The percentage of young adults treated for hypertension who achieved blood pressure control did not significantly change (from 65.0% [95% CI, 55.8%-74.2%] in 2009-2010 to 74.8% [95% CI, 67.5%-82.1%] in 2017-2020], while glycemic control among young adults receiving treatment for diabetes remained suboptimal throughout the study period (2009-2010: 45.5% [95% CI, 27.7%-63.3%]) to 2017-2020: 56.6% [95% CI, 39.2%-73.9%]).Conclusions and RelevanceIn the US, diabetes and obesity increased among young adults from 2009 to March 2020, while hypertension did not change and hyperlipidemia declined. There was variation in trends by race and ethnicity.

Both Moderate and Heavy Alcohol Use Amplify the Adverse Cardiovascular Effects of Smoking in Young Patients with Hypertension

“…Strategies for improving lifestyle behaviors are well recognized and should be applied and reinforced, particularly in young patients with hypertension. Indeed, increases in heart disease and cardiovascular mortality has been reported in recent years in younger adults, which reflect recent unfavorable trends in cardiovascular risk determinants and events [29,46]. Tobacco product use remains high among youth in Western countries [47], calling for the implementation of population-based tobacco control strategies in this segment of the population.…”

“…However, little is known about the combined effect of alcohol and smoking on cardiovascular events, especially in young individuals, despite emerging concerns about the cardiovascular health of this segment of the population. Recent data indicate that treatment and control of major risk factors for cardiovascular disease among young adults are far from optimal and suggest that cardiovascular disease may now be increasing in this population [29][30][31].…”

Diabetes trends in youth

“…Relatively poor glycemic control of youth both with T1D and T2D has been documented in the United States, with mean HbA1c between 8% and 9% and with trends for increasing levels over the past two decades 11 . The pattern of worsening glycemic control over the past decade among patients with T2D in the United States has also been shown to extend to young adults at ages 20–44 12 . The difficulty of treatment among youths with T2D is noteworthy.…”

“…11 The pattern of worsening glycemic control over the past decade among patients with T2D in the United States has also been shown to extend to young adults at ages 20-44. 12 The difficulty of treatment among youths with T2D is noteworthy. A recent study of insulin and/or metformintreated youth with T2D having baseline HbA1c 8%-8.1% showed glycemic worsening with the dipeptidyl peptidase inhibitor linagliptin and only modest improvement with the sodium-glucose cotransporter-2 inhibitor empagliflozin.…”

The Urgent Need to Refocus Cardiovascular Disease Prevention Efforts on Young Adults

“…In this issue of JAMA , Aggarwal and colleagues used the most recent data from the National Health and Nutrition Examination Surveys (NHANES) to examine trends in diagnosis, treatment, and control of cardiovascular risk factors among young adults (aged 20-44 years) from 2009 through 2020. Their findings clearly demonstrate that the burden of cardiovascular risk factors is unacceptably high and increasing in young adults.…”