Vital Signs: Prevalence of Key Cardiovascular Disease Risk Factors for Million Hearts 2022 - United States, 2011-2016

Abstract

Introduction: Despite decades-long reductions in cardiovascular disease (CVD) mortality, CVD mortality rates have recently plateaued and even increased in some subgroups, and the prevalence of CVD risk factors remains high. Million Hearts 2022, a 5-year initiative, was launched in 2017 to address this burden. This report establishes a baseline for the CVD risk factors targeted for reduction by the initiative during 2017-2021 and highlights recent changes over time.

Methods: Risk factor prevalence among U.S. adults was assessed using data from the National Health and Nutrition Examination Survey, National Survey on Drug Use and Health, and National Health Interview Survey. Multivariate analyses were performed to assess differences in prevalence during 2011-2012 and the most recent cycle of available data, and across subgroups.

Results: During 2013-2014, the prevalences of aspirin use for primary and secondary CVD prevention were 27.4% and 74.9%, respectively, and of statin use for cholesterol management was 54.5%. During 2015-2016, the average daily sodium intake was 3,535 mg/day and the prevalences of blood pressure control, combustible tobacco use, and physical inactivity were 48.5%, 22.3%, and 29.1%, respectively. Compared with 2011-2012, significant decreases occurred in the prevalences of combustible tobacco use and physical inactivity; however, a decrease also occurred for aspirin use for primary or secondary prevention. Disparities in risk factor prevalences were observed across age groups, genders, and racial/ethnic groups.

Conclusions and implications for public health practice: Millions of Americans have CVD risk factors that place them at increased risk for having a cardiovascular event, despite the existence of proven strategies for preventing or managing CVD risk factors. A concerted effort to implement these strategies will be needed to prevent one million acute cardiovascular events during the 5-year initiative.

FIGURE 1

Prevalence of Million Hearts 2022 clinical strategies^,, to prevent cardiovascular disease among adults^, — United States, 2011–2012, 2013–2014, and 2015–2016 Source: National Health and Nutrition Examination Survey, National Center for Health Statistics, CDC. Abbreviation: BP = blood pressure. * Aspirin use was defined by an answer of “yes” to the question “Doctors and other health care providers sometimes recommend that you take a low-dose aspirin each day to prevent heart attacks, strokes, or cancer. Have you ever been told to do this?” and an answer of “yes” or “sometimes” to the question “Are you/ now following this advice?”; an answer of “yes” to the question “On your own, are you now taking a low-dose aspirin each day to prevent heart attacks, strokes, or cancer?”; or aspirin identified in the prescription medication data files. Participants who reported taking an anticoagulant in the prescription medication files but not taking aspirin were excluded. Aspirin use for primary prevention includes examined adults aged 50–59 years without a history of cardiovascular disease (CVD) and with an American College of Cardiology/American Heart Association 10-year atherosclerotic CVD risk score ≥10%. Aspirin use of secondary prevention includes examined adults aged ≥40 years with a history of CVD. ^† BP control was defined as an average systolic BP <140 mm Hg and an average diastolic BP <90 mm Hg among adults aged ≥18 years with hypertension. Hypertension is defined as an average systolic BP ≥140 mm Hg, or an average diastolic BP ≥90 mm Hg, or self-reported current use of BP-lowering medication. ^§ Cholesterol management is defined as current statin use, based on the prescription medication data files, among fasting adults aged ≥21 years for whom statin therapy is recommended. ^¶ For aspirin (primary or secondary), t-test p-value <0.01 comparing 2013–2014 with 2011–2012, adjusted for sex, age group, and race/ethnicity. ** For aspirin (primary), t-test p-value <0.05 comparing 2013–2014 with 2011–2012, adjusted for sex and race/ethnicity.

FIGURE 2

Prevalence of Million Hearts 2022 community risk factors^,, for cardiovascular disease among adults — United States, 2011–2012, 2013–2014, and 2015–2016 Source: National Survey on Drug Use and Health; Substance Abuse and Mental Health Services Administration; National Health and Nutrition Examination Survey; National Center for Health Statistics; CDC; National Health Interview Survey (NHIS). * Combustible tobacco use was defined as current use of combustible tobacco products (cigarettes, cigars, or pipe) among adults (aged ≥18 years) with complete data to determine tobacco use. ^† The 2008 Physical Activity Guidelines for Americans (http://www.health.gov/PAGuidelines/) recommend that all adults should avoid inactivity and that some physical activity is better that none. NHIS questions ask about frequency of participation in light to moderate-intensity and vigorous-intensity leisure-time physical activities for at least 10 minutes. Questions are phrased in terms of current behavior and lack a specific reference period. Physical inactivity is defined as reporting no light to moderate or vigorous leisure-time physical activity for at least 10 minutes. ^§ Sodium intake (mg/day) was estimated among adults aged ≥18 years with a complete and reliable first day 24-hour dietary recall (collected in-person at the mobile examination center). ^¶ For combustible tobacco use and physical inactivity, t-test p-values <0.01 comparing 2015–2016 with 2011–2012, adjusted for sex, age group, and race/ethnicity.