by While medical advances in the second half of the 20th century led to a steady decline in cardiovascular mortality, progress has stalled, worrying health professionals.
Researchers at the Harvard-affiliated Beth Israel Deaconess Medical Center analyzed more than a decade of data to examine rates of cardiovascular risk factors — such as high blood pressure, diabetes, obesity and smoking — among American adults from 2009 to March 2020. The study was published in JAMA and presented at the American College of Cardiology Scientific Sessions.
Researchers observed increases in high blood pressure and significant increases in diabetes and obesity rates in young adults, with no significant improvement in blood pressure or glycemic control. Officials are concerned these trends may reflect worsening cardiovascular health among younger adults in their 20s, 30s and 40s. Scientists also observed significant differences in these trends by race and ethnicity.
“The emergence of cardiovascular risk factors at an early age is associated with a higher risk of heart disease and acute events such as myocardial infarction and stroke, resulting in a significant loss in quality of life and years of life,” said corresponding author Rishi K Wadhera, Department Head of Health Policy and Equity at the Smith Center for Outcomes Research in Cardiology at BIDMC. “Therefore, the significant increase in the burden of cardiovascular risk factors in young adults as the population ages will have important public health implications.”
This cross-sectional, serial study included medical data and self-reported information from 12,924 young adults, ages 20 to 44, who participated in the long-running National Health and Nutrition Survey conducted by the Centers for Disease Control and Prevention. The group was made up of 51 percent female, 57 percent white, 12 percent Mexican, 8 percent other Hispanic, 13 percent black, and 10 percent other racial or ethnic backgrounds.
Waterra and colleagues observed that the prevalence of hypertension rose from 9 percent in 2009-2010 to 12 percent a decade later. Similarly, the researchers observed a statistically significant increase in diabetes rates, which climbed from 3 to 4 percent, and obesity, which rose from 33 to 41 percent over the study period. The proportion of young adults with a history of smoking was high and not changing. In contrast, rates of high cholesterol fell from 41 percent in 2009-10 to 36 percent in 2017-20, a drop scientists suspect reflects government regulation of the use of trans fats and other partially hydrogenated oils in packaged foods ready meals and fast food. food restaurants.
The researchers found significant differences in the prevalence of risk factors by race and ethnicity. Mexican Americans were the only group to experience a significant increase in diabetes. Obesity increased significantly in all racial and ethnic groups except black adults. While high blood pressure rates increased among Mexican Americans and other Hispanic adults, black adults experienced the highest high blood pressure rates.
“The prevalence of hypertension in young black adults was at least twice as likely as in all other racial and ethnic groups, with no improvement over the study period,” said first author Rahul Aggarwal, a research associate at the Smith Center and a cardiologist at Brigham and Women’s Hospital. “Black adults have high rates of stroke, heart failure and hypertensive kidney disease, as well as the highest premature cardiovascular mortality rates in the country — in part due to a high burden of hypertension.
“These inequalities are rooted in structural racism. Scalable and realistic solutions are needed—both community-based programs and large-scale health systems initiatives that screen for and treat uncontrolled blood pressure in young black adults, combined with concerted policy efforts to address socioeconomic disparities,” Aggarwal added.
Researchers also looked at treatment and control rates of cardiovascular risk factors in young adults. Treatment rates for high blood pressure did not change significantly during the study, with only about 55 percent of young adults with high blood pressure being treated. However, among those treated, more than three-quarters of people achieved target blood pressure in 2017-20. Diabetes treatment rates were also low, with one in two young adults being treated for their diabetes. Almost half of young adults treated for diabetes had poor blood sugar control.
“The suboptimal treatment rates for hypertension and diabetes are worrying and may be because many young adults are unaware of their diagnosis,” said Waterra, who is also an assistant professor of medicine at Harvard Medical School. “The rise in cardiovascular risk factors we are observing could lead to higher lifetime rates of heart attack, stroke and heart failure, and have significant long-term public health implications. Our findings should be a call to action to increase public health and clinical interventions focused on the prevention and management of cardiovascular risk factors in young adults.”
Co-authors included Robert W. Yeh of BIDMC; and Karen E. Joynt-Maddox of Washington University School of Medicine.
Disclosures: Yeh receives research support from the National Heart, Lung and Blood Institute and the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology and receives personal honoraria from Biosense Webster, grants and personal honoraria from Abbott Vascular, AstraZeneca, Boston Scientific and Medtronic, outside of the submitted work. Waterra receives research support from the NHBLI. He currently serves as a consultant for Abbott and CVS Health outside of submitted work. A full list of disclosures can be found in the publication.
This study was funded by the National Heart, Lung and Blood Institute (grant R01HL164561).
