Monitoring cardiovascular risk factors in the US population
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Transcript of Monitoring cardiovascular risk factors in the US population
National Center for Health StatisticsDivision of Health and Nutrition Examination Surveys
Monitoring cardiovascular risk factors in the US
populationCynthia Ogden, PhD, MRP & Cheryl Fryar, MSPH
U.S. population-based estimates of:
• Health conditions
• Awareness, treatment and control of selected diseases
• Environmental exposures
• Nutritional status and diet behaviors
Goals of National Health and Nutrition Examination Surveys
(NHANES)
National Health and Nutrition Examination Surveys
NHES I 1960-62 18-79 yearsNHES II 1963-65 6-11 yearsNHES III 1966-70 12-17 yearsNHANES I 1971-75 1-74 yearsNHANES II 1976-80 6 mo.-74 yearsHHANES 1982-84 6 mo.-74 yearsNHANES III 1988-94 2 mo. +
Survey Dates Ages
NHANES 1999-2000 All agesNHANES 2001-2002 All agesNHANES 2003-2004 All agesNHANES 2005-2006 All agesNHANES 2007-2008 All agesNHANES 2009-2010 All agesNHANES 2011-2012 All ages
Survey Dates Ages
OP96S025
National Health and Nutrition Examination Surveys
Sample• US Civilian, non-institutionalized
population
• All ages
• Oversample:–African Americans–Asian Americans–Hispanics/Latinos–Older persons aged 60+–Low income whites
Stage 4SPs
Stage 1Counties
Stage 2Segments
Stage 3Households
• Broad range of health conditions
• Health-related behaviors and exposures
• Health care utilization
• Health insurance
• Prescription medications
• Dietary supplements
Interview
Mobile examination center
Cardiovascular health
Laboratory
Mobile exam center laboratory
• Complete blood count• Pregnancy test• Specimen processing
Blood, urine, water, swabs, wipes300 assays24 laboratories
Laboratory tests
• Nutritional biomarkers• Hormone tests• Diabetes• Lipids, CRP• Biochemistry profile• Infectious diseases• Environmental exposures
NHANES response rates1999-2010
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 201060
65
70
75
80
85
90
InterviewedExamined
%
Both sexes Men Women0
5
10
15
20
25
30
13.412.2
14.3 313.511.4
15.4 3
10.3 10.2 10.3
14.5 2 15.4 1,213.2
All race ethnic groups NH whiteNH black Hispanics
Greater than or equal to 240 mg/dL; 1 Significantly different from non-Hispanic white; 2 Significantly different from non-Hispanic black; 3 Significantly different from men in the same race/ethnicity group. SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey. Carroll et al NCHS Data Brief 2012
Percent of adults with high serum total cholesterol, US, 2009-2010
Percent
Trends in the percent of adults with high serum total cholesterol, US, 1999-2010
40-59 years 60 years and older
1999-2000
2001-2002
2003-2004
2005-2006
2007-2008
2009-2010
0
5
10
15
20
25
30
35
Men Women HP 2010
1999-2000
2001-2002
2003-2004
2005-2006
2007-2008
2009-2010
0
5
10
15
20
25
30
35
Men Women HP 2010
† A serum total cholesterol greater than or equal to 240 mg/dL *Significant decreasing trends (p<0.005) NOTES: HP 2010 = Healthy People 2010 Objective (17%). SOURCE:CDC/NCHS, National Health and Nutrition Examination Survey,.
***
Percent Percent
Both sexes Men Women0
5
10
15
20
25
30
35
40
21.3
31.4
11.9 3
21.3
31.9
11 3
16.4 1
20.7 1
12.93
24.8 2
35.1 2
14.6 3
All race ethnic groups NH WhiteNH black Hispanics
†Less than 40 mg/dL 1 Significantly different from non-Hispanic white 2 Significantly different from non-Hispanic black 3 Significantly different from men in the same race/ethnicity group SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey
Percent of adults with low HDL, US, 2009-2010
Percent
Analysis Linking Health Insurance Questionnaire and Exam Data
NHANES and Million Hearts
Status of the ABCS
Aspirin People at increased risk of cardiovascular disease who are taking aspirin
47%
Blood pressure
People with hypertension who have adequately controlled blood pressure
46%
Cholesterol People with high cholesterol who have adequately controlled hyperlipidemia
33%
Smoking People trying to quit smoking who get help 23%
Source: MMWR: Million Hearts: Strategies to Reduce the Prevalence of Leading Cardiovascular Disease Risk Factors --- United States, 2011, Early Release, Vol. 60
The 3 Risk Factors
Uncontrolled High Blood Pressure
Measured systolic blood pressure ≥140 mm Hg or a diastolic blood pressure ≥90 mm Hg, based on the average of up to three measurements
Persons may or may not have been taking medication
Uncontrolled High LDL-Cholesterol
Measured levels of LDL cholesterol above the treatment goals established by the National Cholesterol Education Program (NCEP) Adult Treatment Panel-III (ATP-III) guidelines: <160 mg/dL, <130 mg/dL, and <100 mg/dL for low-, intermediate-, and high-risk groups, respectively.
Persons may or may not have been taking medication.
Smoker
Person reporting that they smoked at least 100 cigarettes in their lifetime and now smoke every day or some days, or a measured serum cotinine (the primary nicotine metabolite) level >10 ng/mL.
1999-2000
2001-2002
2003-2004
2005-2006
2007-2008
2009-2010
0
20000000
40000000
60000000
80000000
100000000
120000000
140000000
20
30
40
50
60
70
80
90
100
109,096,467109,478,535111,305,348108,417,722107,342,094102,510,405
57.8 55.354.2 51.5 49.7 46.5
Mil
lion
s
Per
cent
Prevalence and number of US adults who smoke or have uncontrolled high BP or uncontrolled
high cholesterol
Linear trend in prevalence significant (p<0.01) after adjustment for sex, age group, race/ethnicity, and poverty-income ratio. MMWR Sept 2011. Updated with 2009-10 data.
Percentage of US adults with at least 1 risk factor
Total 20-39 years 40-59 years 60 + years0
10
20
30
40
50
60
46.541.8
47.0
53.751.648.6
53.8 53.4
41.2
34.4
40.5
53.9
Both Male Female
Percent
Source: CDC/NCHS, National Health and Nutrition Examination Survey 2009-2010
Source: National Health and Nutrition Examination Surveys; Fryar et al 2012 NCHS Data Brief
Percentage of men with at least 1 risk factor, by age:
US, 1999-2010
1999-2000 2001-2002 2003-2004 2005-2006 2007-2008 2009-201030
35
40
45
50
55
60
65
70
75
80
54.551.9
54 55 56
48.6
71.4
63.8 62.6
57.7
57.9
53.8
73.7
70.1 70.8
64.4
54.9
53.4
20-39 y 40-59 y 60+ y
Perc
ent
Source: National Health and Nutrition Examination Surveys; Fryar et al 2012 NCHS Data Brief
Percentage of women with at least 1 risk factor, by age: US, 1999-2010
1999-2000 2001-2002 2003-2004 2005-2006 2007-2008 2009-201030
35
40
45
50
55
60
65
70
75
80
38.7
34.136.1 37.1 31.1
34.4
44.7
52.7
48.1
42.8
46.1
40.5
78.3
73.2
65.3
61.2
57.153.9
20-39 y 40-59 y 60+ y
Perc
ent
1999-2000
2001-2002
2003-2004
2005-2006
2007-2008
2009-2010
20-39 40-59 60+
1999-2000 2001-2002 2003-2004 2005-2006 2007-2008 2009-201030
40
50
60
70
80
90
100
Men Women
Source: National Health and Nutrition Examination Surveys; Fryar et al 2012 NCHS Data Brief
Percentage of adults with at least 1 risk factor, by sex and age: US, 1999-2010
• 1999-2010 decrease
Men 40-59 and 60+ years Women 60+ years
• Men more likely
• Older women more likely than younger
Sex specific results
Source: National Health and Nutrition Examination Surveys; Fryar et al 2012 NCHS Data Brief
Percentage of adults with at least 1 risk factor, by race/ethnicity: US, 1999-2010
1999-2000 2001-2002 2003-2004 2005-2006 2007-2008 2009-20100
10
20
30
40
50
60
70
58.154.8 54.6
52.649.5
46.9
62.2 63.759.9
55.2
61.657.8
51.7 51.4 50.4
43.2 44.6 44.6
non-Hispanic white non-Hispanic black Mexican American
Percent
• 1999-2010 decrease
Non-Hispanic white adults Mexican American adults
• Non-Hispanic black adults more likely
1 12
Race/ethnicity specific results
Source: National Health and Nutrition Examination Surveys; Fryar et al 2012 NCHS Data Brief
Percentage of adults with at least 1 risk factor, by poverty level: US, 1999-2010
1999-2000 2001-2002 2003-2004 2005-2006 2007-2008 2009-20100
10
20
30
40
50
60
70
80
70.265.5
63.259.8
66.4
60.662.7 61.6 59.9
56.8
49.547.2
49.546 45.7 44 42.6
37.9
<130% poverty 130-350% poverty >350% poverty
Percent
• 1999-2010 decrease
All income groups
• Lowest income adults more at likely
1,21,2 1,2PIR specific results
Source: National Health and Nutrition Examination Surveys; Fryar et al 2012 NCHS Data Brief
Percentage of adults who smoke: US, 1999-2010
1999-2000 2001-2002 2003-2004 2005-2006 2007-2008 2009-20100
10
20
30
40
50
60
70
28.3 28.330.5 31.1
2825.1Pe
rcen
t
Source: National Health and Nutrition Examination Surveys; Fryar et al 2012 NCHS Data Brief
Percentage of adults with uncontrolled high LDL cholesterol: US, 1999-2010
1999-2000 2001-2002 2003-2004 2005-2006 2007-2008 2009-20100
10
20
30
40
50
60
70
32.629.1
24.621.9 21.9 23.3
Perc
ent
Source: National Health and Nutrition Examination Surveys; Fryar et al 2012 NCHS Data Brief
Percentage of adults with uncontrolled high blood pressure: US, 1999-2010
1999-2000 2001-2002 2003-2004 2005-2006 2007-2008 2009-20100
10
20
30
40
50
60
70
19.4 18.7 17.2 15.813.2 11.8
Perc
ent
Source: National Health and Nutrition Examination Surveys; Fryar et al 2012 NCHS Data Brief
Percentage of adults with at least 1 risk factor:
US, 1999-2010
1999-2000 2001-2002 2003-2004 2005-2006 2007-2008 2009-20100
10
20
30
40
50
60
70
57.855.3 54.2
51.549.7
46.5
Perc
ent
• 1999-2010 decrease
Uncontrolled high blood pressure
Uncontrolled high LDL cholesterol
1 1 1
Individual risk factors
NHANES and CVD risk factors
• NHANES resource for monitoring trends
• Percent of US adults with 1+ risk factorDecrease 1999-2010 Not among African Americans Men, older adults, African Americans, lower
income adults more likely to have risk factors
• Percent of US adults with Individual risk factors Decrease in uncontrolled high blood
pressure and uncontrolled high LDL cholesterol
No significant change in smoking
Thank you to our colleagues
Margaret Carroll, MSPHTe-Ching Chen, PhD
Xianfen Li, MS
Disclaimer
The findings and conclusions in this presentation are those of the author and not necessarily of CDC