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Twenty-year trends in cardiovascular risk among men and women in the United States.

ABSTRACT: BACKGROUND:Relative to men, women have experienced slower improvement in mortality in the US in recent decades. AIMS:We investigated 20-year trends in cardiovascular risk for men and women age 40 and over in the US to determine whether there was differential change in risk for men and women. METHODS:Using the National Health and Nutrition Examination Survey (NHANES), we estimated total cardiovascular risk, the prevalence of individual risk factors, and potential factors contributing to change in risk. RESULTS:Men showed steady reductions in cardiovascular risk over the 20 years; women experienced increased risk from 1990 to 2000, but decreased risk from 2000 to 2010. Sex differences in cardiovascular risk changed so that there was no significant difference by sex at any age over 50 in 2010. Large decreases in the prevalence of high risk lipids were important causes of reduction in risks for both sexes; changes in blood pressure were less important, except for women in the 2000-2010 period when they equaled the effect of changing lipids. Increasing medication usage and effectiveness drove improvements in blood pressure and total cholesterol for both sexes. In 2010 there was no difference between men and women in the use of antihypertensives or cholesterol-lowering medications. Metabolic risk, as indexed by obesity and HbA1c, increased over time and went against the trend in the summary measure. Diabetes, smoking, and hormone therapy use did not explain changes in high blood pressure or high total cholesterol for either gender. CONCLUSIONS:Recent decreases in cardiovascular risk may lead to future reduction in cardiovascular events and mortality among both women and men.

SUBMITTER: Kim JK

PROVIDER: S-EPMC6151160 | biostudies-literature | 2019 Jan

REPOSITORIES: biostudies-literature

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Twenty-year trends in cardiovascular risk among men and women in the United States.

Kim Jung Ki JK Ailshire Jennifer A JA Crimmins Eileen M EM

Aging clinical and experimental research 20180322 1

<h4>Background</h4>Relative to men, women have experienced slower improvement in mortality in the US in recent decades.<h4>Aims</h4>We investigated 20-year trends in cardiovascular risk for men and women age 40 and over in the US to determine whether there was differential change in risk for men and women.<h4>Methods</h4>Using the National Health and Nutrition Examination Survey (NHANES), we estimated total cardiovascular risk, the prevalence of individual risk factors, and potential factors con ...[more]

PMID: 29569117

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Project description:ImportanceMedicare and other organizations have focused on improving quality of care for patients with acute myocardial infarction (AMI) over the last 2 decades. However, there is no comprehensive perspective on the evolution of outcomes for AMI during that period, and it is unknown whether temporal changes varied by patient subgroup, hospital, or county.ObjectiveTo provide a comprehensive evaluation of national trends in inpatient outcomes and costs of AMI during this period.Design, setting, and participantsThis cohort study included analysis of data from a sample of 4 367 485 Medicare fee-for-service beneficiaries aged 65 years or older from January 1, 1995, through December 31, 2014, across 5680 hospitals in the United States. Analyses were conducted from January 15 to June 5, 2018.Main outcomes and measuresThirty-day all-cause mortality at the patient, hospital, and county levels. Additional outcomes included 30-day all-cause readmissions; 1-year recurrent AMI; in-hospital mortality; length of hospital stay; 2014 Consumer Price Index-adjusted median Medicare inpatient payment per AMI discharge; and rates of catheterization, percutaneous coronary intervention, and coronary artery bypass graft surgery.ResultsThe cohort included 4 367 485 Medicare fee-for-service patients aged 65 years or older hospitalized for AMI during the study period. Between 1995 and 2014, the mean (SD) age of patients increased from 76.9 (7.2) to 78.2 (8.7) years, the percentage of female patients declined from 49.5% to 46.1%, the percentage of white patients declined from 91.0% to 86.2%, and the percentage of black patients increased from 5.9% to 8.0%. There were declines in AMI hospitalizations (914 to 566 per 100 000 beneficiary-years); 30-day mortality (20.0% to 12.4%; difference, 7.6 percentage points; 95% CI, 7.3-7.8 percentage points); 30-day all-cause readmissions (21.0% to 15.3%; difference, 5.7 percentage points; 95% CI, 5.4-6.0 percentage points); and 1-year recurrent AMI (7.1% to 5.1%; difference, 2.0 percentage points; 95% CI, 1.8-2.2 percentage points). There were increases in the 2014 Consumer Price Index-adjusted median (interquartile range) Medicare inpatient payment per AMI discharge ($9282 [$6969-$12 173] to $11 031 [$8099-$16 861]); 30-day inpatient catheterization (44.2% to 59.9%; difference, 15.7 percentage points; 95% CI, 15.4-16.0 percentage points); and inpatient percutaneous coronary intervention (18.8% to 43.3%; difference, 24.5 percentage points; 95% CI, 24.2-24.7 percentage points). Coronary artery bypass graft surgery rates decreased from 14.4% to 10.2% (difference, 4.2 percentage points; 95% CI, 3.9-4.3 percentage points). There was heterogeneity by hospital and county in the mortality changes over time.Conclusions and relevanceThis study shows marked improvements in short-term mortality and readmissions, with an increase in in-hospital procedures and payments, for the increasingly smaller number of Medicare beneficiaries with AMI.

Project description:Studies evidenced that reduction in cardiovascular disease (CVD) mortality in diabetic patients can be attributed to improvements in major CVD risk factors and evidence-based treatments. Furthermore, studies showed that the relative risk of CVD mortality associated with diabetes compared with non-diabetes is stronger in women than in men. Hence, we aimed to examine trends in CVD risk factors and intervention measures by sex and diabetic status.Analysis of 5 distinct cross-sectional National Health and Nutrition Examination Surveys, 1988-1994, 1999-2002, 2003-2006, 2007-2010, and 2010-2014. Since detailed information on nontraditional risk factors such as sleep apnea was not available in each NHANES survey, traditional CVD risk factors including obesity, hypertension, and dyslipidemia were assessed in the study. To assess whether changes throughout the 27-year period differed by diabetes status, a logistic regression analysis was utilized to examine potential interaction effects between survey and diabetes. The similar process was repeated for sex.Means of all risk factors except body mass index and waist circumference decreased and the prevalence of antihypertensive and lipid-lowering medication use increased over time among diabetic and non-diabetic men and women. For both men and women, survey?×?diabetes status interaction terms for changes in HDL-cholesterol and triglyceride levels were not statistically significant, while the prevalence of antihypertensive and lipid-lowering medication use increased more in diabetic than in non-diabetic persons (all P?<?0.001). For women, survey?×?diabetes status interaction terms indicated that compared with the first survey, total cholesterol, LDL-cholesterol, and non-HDL-cholesterol fallen more in diabetic than in non-diabetic persons (all P?<?0.001). In the diabetic state, men experienced similar changes in means of all CVD risk factors and the prevalence of antihypertensive and lipid-lowering medication use as women (all P for interactions between survey and sex were >0.01).The major traditional CVD risk factors in diabetic men decreased to the same extent that they did for non-diabetic men. The magnitude of changes in the favorable trends in diabetic women was of similar or greater compared with those among non-diabetic women. Diabetic women had as good an improvement in CVD risk factors as diabetic men.

Project description:BackgroundCardiovascular disease (CVD) is the leading cause of mortality worldwide; however, the epidemiology of CVD among nationals from the United Arab Emirates (UAE) remains unknown. This study aimed to estimate the 9-year incidence rate of CVD and determine the risk factors associated with CVD among UAE nationals at high cardiovascular risk. In addition, we investigated whether sex was an important modifier of the risk factors associated with incident CVD in this population.MethodsA retrospective cohort study was conducted on 977 subjects, including 492 women, aged ?18?years, who did not have histories of CVD, and who had ?1 CVD risk factors. Multivariable Cox proportional hazards regression analyses stratified by sex were used to examine the predictors of major CVD events, namely, myocardial infarction (MI), stroke, and acute peripheral arterial occlusion.ResultsDuring a median follow-up period of 8.9?years, the incidence rate of major CVD was 12.7 per 1000 person-years (95% confidence interval [CI] 10.4-15.4), and among men and women were 16.8 (95% CI 12.9-21.4) and 9.0 (95% CI 6.4-12.4) per 1000 person-years, respectively. Major CVD and MI were significantly more frequent among men than women, and the stroke and acute peripheral arterial occlusion rates were similar for both sexes. Multivariable Cox analyses showed that the systolic blood pressure, estimated glomerular filtration rate, and serum glycosylated hemoglobin A1c level were strong predictors of major CVD in both sexes. Among women, the total cholesterol (TC)-to-high-density lipoprotein-cholesterol (HDL-C) ratio (hazard ratio [HR] 1.44, 95% CI 1.02-2.04) was an additional independent predictor of major CVD. Age (HR 1.50, 95% CI 1.19-1.89) and a history of smoking (HR 1.80, 95% CI 1.07-3.02) were significant risk factors associated with major CVD in men.ConclusionsAmong high-risk UAE nationals who did not have histories of CVD, the risk of major CVD was associated with high systolic blood pressure, a low estimated glomerular filtration rate, and poorly controlled diabetes. The high TC-to-HDL-C ratios, especially among women, and smoking among men, are modifiable risk factors that should be managed aggressively.

Project description:The disease risks from cigarette smoking increased in the United States over most of the 20th century, first among male smokers and later among female smokers. Whether these risks have continued to increase during the past 20 years is unclear.We measured temporal trends in mortality across three time periods (1959-1965, 1982-1988, and 2000-2010), comparing absolute and relative risks according to sex and self-reported smoking status in two historical cohort studies and in five pooled contemporary cohort studies, among participants who became 55 years of age or older during follow-up.For women who were current smokers, as compared with women who had never smoked, the relative risks of death from lung cancer were 2.73, 12.65, and 25.66 in the 1960s, 1980s, and contemporary cohorts, respectively; corresponding relative risks for male current smokers, as compared with men who had never smoked, were 12.22, 23.81, and 24.97. In the contemporary cohorts, male and female current smokers also had similar relative risks for death from chronic obstructive pulmonary disease (COPD) (25.61 for men and 22.35 for women), ischemic heart disease (2.50 for men and 2.86 for women), any type of stroke (1.92 for men and 2.10 for women), and all causes combined (2.80 for men and 2.76 for women). Mortality from COPD among male smokers continued to increase in the contemporary cohorts in nearly all the age groups represented in the study and within each stratum of duration and intensity of smoking. Among men 55 to 74 years of age and women 60 to 74 years of age, all-cause mortality was at least three times as high among current smokers as among those who had never smoked. Smoking cessation at any age dramatically reduced death rates.The risk of death from cigarette smoking continues to increase among women and the increased risks are now nearly identical for men and women, as compared with persons who have never smoked. Among men, the risks associated with smoking have plateaued at the high levels seen in the 1980s, except for a continuing, unexplained increase in mortality from COPD.

Project description:ImportanceIncome disparity between persons with the most resources (the top 20% of earners) and the remainder of the population in the United States has dramatically widened over the past few decades. Given the well-established association between income and health, this increasing income gap may provide insights into the dynamics of cardiovascular disease (CVD) burden among adults in the US.ObjectiveTo quantify the contribution of people in the highest-resources group and the remainder of the population to the burden of CVD, and to estimate the trends in the prevalence of CVD for the 2 groups in the United States from 1999 to 2016.Design, setting, and participantsThis serial cross-sectional analysis used nationally representative data from 9 cycles of the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2016. Survey participants were adults 20 years or older. Statistical analysis of the data was conducted in December 2019.Main outcomes and measuresAge-standardized prevalence of CVD was calculated using the 2010 census estimates. Participants were stratified by income group using the NHANES income to poverty ratio, which was converted into a binary variable: a ratio of 5 or greater for the highest-resources group and a ratio of less than 5 for the remainder of the population.ResultsThis analysis included 44 986 participants. Among the 7926 participants in the highest-resources group, 3290 (50.3%) were in the 40- to 59-year age group and 4094 (51.9%) were men. Among the 37 060 participants in the remainder of the population, 10 840 (34.1%) were in the 40- to 59-year age group and 19 470 (53.2%) were women. The age-standardized prevalence of CVD decreased in the highest-resources group during the study period (1999-2016): angina from 3.4% (n = 24) to 0.3% (n = 5), heart attack from 3.2% (n = 24) to 1.4% (n = 19), congestive heart failure (CHF) from 1.2% (n = 11) to 0.5% (n = 7), and stroke from 1.1% to 1.0% (n = 8). In the remainder of the population, the prevalence of angina decreased from 3.3% (n = 131) in 1999 to 2.6% (n = 118) in 2016 and heart attack from 4.0% (n = 160) in 1999 to 3.6% (n = 201) in 2016. Conversely, an increase was observed in the prevalence of CHF from 2.6% (n = 123) in 1999 to 2.8% (n = 176) in 2016 and stroke from 2.9% (n = 152) in 1999 to 3.2% (n = 178) in 2016. Over time, the odds of reporting angina (odds ratio [OR], 0.80; 95% CI, 0.73-0.87; P < .001), heart attack (OR, 0.91; 95% CI, 0.86-0.97; P = .003), and CHF (OR, 0.90; 95% CI, 0.82-0.99; P = .03) decreased among those in the highest-resources group, while there was no significant change in the odds of reporting stroke (OR, 0.97; 95% CI, 0.90-1.05; P = .43). Among the remainder of the population, the odds of reporting angina (OR, 0.95; 95% CI, 0.92-0.99; P < .05) and heart attack (OR, 0.99; 95% CI, 0.97-1.02; P = .06) decreased over time. Conversely, there was no statistically significant change in the odds of reporting CHF (OR, 1.02; 95% CI, 1.00-1.05; P = .08) and stroke (OR, 1.02; 95% CI, 0.99-1.04; P = .21).Conclusions and relevanceThis study found substantial and increasing disparities in CVD prevalence between the richest and poorest participants in the NHANES from 1999 to 2016, with lower CVD rate reported among the highest-resources group. Additional research into the dynamics of income inequality and health outcomes as well as policy and public health efforts to mitigate this inequality are needed.

Dataset Information

Twenty-year trends in cardiovascular risk among men and women in the United States.

Publications

Twenty-year trends in cardiovascular risk among men and women in the United States.

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