Cardiovascular Health Behavior and Health Factor Changes (1988―2008) and Projections to 2020: Results From the National Health and Nutrition Examination Surveys

• Published in: Circulation (New York, N.Y.) Vol. 125; no. 21; pp. 2595 - 2602
• Main Authors: HUFFMAN, Mark D, CAPEWELL, Simon, HONGYAN NING, SHAY, Christina M, FORD, Earl S, LLOYD-JONES, Donald M
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 29-05-2012
• Subjects: Adult; Aged; Aged, 80 and over; American Heart Association; Biological and medical sciences; Blood and lymphatic vessels; Body Mass Index; Cardiology. Vascular system; Cardiovascular Diseases - epidemiology; Diet - adverse effects; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Health Behavior; Humans; Hypercholesterolemia - complications; Hypercholesterolemia - epidemiology; Hyperglycemia - complications; Hyperglycemia - epidemiology; Hypertension - complications; Hypertension - epidemiology; Male; Medical sciences; Middle Aged; Miscellaneous; Motor Activity - physiology; Nutrition Surveys - trends; Prevalence; Public health. Hygiene; Public health. Hygiene-occupational medicine; Retrospective Studies; Risk Factors; Smoking - adverse effects; Smoking - physiopathology; United States - epidemiology; United States; Cardiovascular disease; risk factors; cardiovascular disease risk factors; Epidemiology; trends; Risk factor
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.111.070722

The American Heart Association's 2020 Strategic Impact Goals target a 20% relative improvement in overall cardiovascular health with the use of 4 health behavior (smoking, diet, physical activity, body mass) and 3 health factor (plasma glucose, cholesterol, blood pressure) metrics. We sought to define current trends and forward projections to 2020 in cardiovascular health.
We included 35 059 cardiovascular disease-free adults (aged ≥20 years) from the National Health and Nutrition Examination Survey 1988-1994 and subsequent 2-year cycles during 1999-2008. We calculated population prevalence of poor, intermediate, and ideal health behaviors and factors and also computed a composite, individual-level Cardiovascular Health Score for all 7 metrics (poor=0 points; intermediate=1 point; ideal=2 points; total range, 0-14 points). Prevalence of current and former smoking, hypercholesterolemia, and hypertension declined, whereas prevalence of obesity and dysglycemia increased through 2008. Physical activity levels and low diet quality scores changed minimally. Projections to 2020 suggest that obesity and impaired fasting glucose/diabetes mellitus could increase to affect 43% and 77% of US men and 42% and 53% of US women, respectively. Overall, population-level cardiovascular health is projected to improve by 6% overall by 2020 if current trends continue. Individual-level Cardiovascular Health Score projections to 2020 (men=7.4 [95% confidence interval, 5.7-9.1]; women=8.8 [95% confidence interval, 7.6-9.9]) fall well below the level needed to achieve a 20% improvement (men=9.4; women=10.1).
The American Heart Association 2020 target of improving cardiovascular health by 20% by 2020 will not be reached if current trends continue.