Awareness of Cardiovascular Risk Factors in U.S. Young Adults Aged 18-39 Years

Emily M Bucholz, Holly C Gooding, Sarah D de Ferranti, Emily M Bucholz, Holly C Gooding, Sarah D de Ferranti

Abstract

Introduction: Young adults with hyperlipidemia, hypertension, and diabetes are at increased risk of developing heart disease later in life. Despite emphasis on early screening, little is known about awareness of these risk factors in young adulthood.

Methods: Data from the nationally representative cross-sectional National Health and Nutrition Examination Survey 2011-2014 were analyzed in 2017 to estimate the prevalence of self-reported awareness of hypercholesterolemia, hypertension, and diabetes in U.S. young adults aged 18-39 years (n=11,083). Prevalence estimates were weighted to population estimates using survey procedures, and predictors of awareness were identified using weighted logistic regression.

Results: Among U.S. young adults, the prevalence of hypercholesterolemia, hypertension, and diabetes was 8.8% (SE=0.4%); 7.3% (SE=0.3%); and 2.6% (SE=0.2%), respectively. The prevalence of borderline high cholesterol, blood pressure, and blood glucose were substantially higher (21.6% [SE= 0.6%]; 26.9% [SE=0.7%]; and 18.9% [SE=0.6%], respectively). Awareness was low for hypercholesterolemia (56.9% [SE=2.4%]) and moderate for hypertension and diabetes (62.7% [SE=2.4%] and 70.0% [SE=2.7%]); <25% of young adults with borderline levels of these risk factors were aware of their risk. Correlates of risk factor awareness included older age, insurance status, family income above the poverty line, U.S. origin, having a usual source of health care, and the presence of comorbid conditions.

Conclusions: Despite the high prevalence of cardiovascular risk factors in U.S. young adults, awareness remains less than ideal. Interventions that target access may increase awareness and facilitate achieving treatment goals in young adults.

Copyright © 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1
Figure 1
Prevalence of cardiovascular risk factors in U.S young adults aged 18–39 years from the National Health and Nutrition Examination Survey 2005–2014. aBorderline high cholesterol was defined as total cholesterol (fasting or nonfasting [2.2%]) 200–239mg/dL and high cholesterol was defined as total cholesterol ≥240mg/dL or self-reported use of cholesterol-lowering agent. Hypertension was defined as blood pressure ≥140/90mmHg averaged over three measurements or self-reported use of blood pressure lowering agent. Borderline hypertension was defined as average blood pressure 120–139/80–89mmgHg. Diabetes was defined as fasting blood glucose ≥126mg/dL or hemoglobin A1c ≥6.5%. Or self-reported use of insulin or oral agents. Borderline diabetes was defined as fasting blood glucose 100–125mg/dL or hemoglobin A1c 5.7–6.4%.
Figure 2
Figure 2
Percentage of young adults (aged 18 to 30 years) with high or borderline levels of cholesterol, blood pressure, and blood glucose reporting awareness of their risk factor from the National Health and Nutrition Examination Survey 2005–2014.
Appendix Figure 1
Appendix Figure 1
Overlap of hypercholesterolemia, hypertension, and diabetes in U.S. young adults aged 18–39 years.
Appendix Figure 2
Appendix Figure 2
Overlap of high and borderline hypercholesterolemia, hypertension, and diabetes in U.S. young adults aged 18–39 years.
Appendix Figure 3
Appendix Figure 3
Percentage of young adults with a single or multiple risk factors reporting awareness of hypercholesterolemia, hypertension, or diabetes.

References

    1. Berenson GS, Srinivasan SR, Bao W, Newman WP, 3rd, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. N Engl J Med. 1998;338(23):1650–1656. .
    1. Berenson GS, Wattigney WA, Tracy RE, et al. Atherosclerosis of the aorta and coronary arteries and cardiovascular risk factors in persons aged 6 to 30 years and studied at necropsy (The Bogalusa Heart Study) Am J Cardiol. 1992;70(9):851–858. .
    1. Li S, Chen W, Srinivasan SR, et al. Childhood cardiovascular risk factors and carotid vascular changes in adulthood: the Bogalusa Heart Study. JAMA. 2003;290(17):2271–2276. .
    1. Loria CM, Liu K, Lewis CE, et al. Early adult risk factor levels and subsequent coronary artery calcification: the CARDIA Study. J Am Coll Cardiol. 2007;49(20):2013–2020. .
    1. McGill HC, Jr, McMahan CA, Gidding SS. Preventing heart disease in the 21st century: implications of the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) study. Circulation. 2008;117(9):1216–1227. .
    1. Navar-Boggan AM, Peterson ED, D’Agostino RB, Sr, Neely B, Sniderman AD, Pencina MJ. Hyperlipidemia in early adulthood increases long-term risk of coronary heart disease. Circulation. 2015;131(5):451–458. .
    1. Pletcher MJ, Bibbins-Domingo K, Liu K, et al. Nonoptimal lipids commonly present in young adults and coronary calcium later in life: the CARDIA study. Ann Intern Med. 2010;153(3):137–146. .
    1. Pletcher MJ, Vittinghoff E, Thanataveerat A, Bibbins-Domingo K, Moran AE. Young adult exposure to cardiovascular risk factors and risk of events later in life: the Framingham Offspring Study. PloS One. 2016;11:e0154288. .
    1. Raynor LA, Schreiner PJ, Loria CM, Carr JJ, Pletcher MJ, Shikany JM. Associations of retrospective and concurrent lipid levels with subclinical atherosclerosis prediction after 20 years of follow-up: the Coronary Artery Risk Development in Young Adults (CARDIA) study. Ann Epidemiol. 2013;23(8):492–497. .
    1. Stamler J, Stamler R, Neaton JD, et al. Low risk-factor profile and long-term cardiovascular and noncardiovascular mortality and life expectancy: findings for 5 large cohorts of young adult and middle-aged men and women. JAMA. 1999;282(21):2012–2018. .
    1. Stamler J, Dyer AR, Shekelle RB, Neaton J, Stamler R. Relationship of baseline major risk factors to coronary and all-cause mortality, and to longevity: findings from long-term follow-up of Chicago cohorts. Cardiology. 1993;82(2–3):191–222. .
    1. Burke GL, Arnold AM, Bild DE, et al. Factors associated with healthy aging: the cardiovascular health study. J Am Geriatr Soc. 2001;49(3):254–262. .
    1. Integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Bethesda, MD: National Heart, Lung, and Blood Institute; 2012.
    1. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics. 2011;128(suppl 5):S213–256. .
    1. Lin KW, Brown TR. Screening for lipid disorders in adults. Am Fam Physician. 2009;80(11):1281–1282.
    1. U.S. Preventive Services Task Force. Final update summary: lipid disorders in adults (cholesterol, dyslipidemia): screening. Published 2008.
    1. Casagrande SS, Menke A, Cowie CC. Cardiovascular risk factors of adults age 20–49 years in the United States, 1971–2012: a series of cross-sectional studies. PloS One. 2016;11:e0161770. .
    1. Cheung BM, Ong KL, Man YB, Lam KS, Lau CP. Prevalence, awareness, treatment, and control of hypertension: United States National Health and Nutrition Examination Survey 2001–2002. J Clin Hypertension. 2006;8(2):93–98. .
    1. Cutler JA, Sorlie PD, Wolz M, Thom T, Fields LE, Roccella EJ. Trends in hypertension prevalence, awareness, treatment, and control rates in United States adults between 1988–1994 and 1999–2004. Hypertension. 2008;52(5):818–827. .
    1. Kuklina EV, Yoon PW, Keenan NL. Prevalence of coronary heart disease risk factors and screening for high cholesterol levels among young adults, United States, 1999–2006. Ann Fam Med. 2010;8(4):327–333. .
    1. Ong KL, Cheung BM, Man YB, Lau CP, Lam KS. Prevalence, awareness, treatment, and control of hypertension among United States adults 1999–2004. Hypertension. 2007;49(1):69–75. .
    1. Ayanian JZ, Zaslavsky AM, Weissman JS, Schneider EC, Ginsburg JA. Undiagnosed hypertension and hypercholesterolemia among uninsured and insured adults in the Third National Health and Nutrition Examination Survey. Am J Public Health. 2003;93(12):2051–2054. .
    1. Cowie CC, Rust KF, Byrd-Holt DD, et al. Prevalence of diabetes and impaired fasting glucose in adults in the U.S. population: National Health And Nutrition Examination Survey 1999–2002. Diabetes Care. 2006;29(6):1263–1268. .
    1. Ford ES, Mokdad AH, Giles WH, Mensah GA. Serum total cholesterol concentrations and awareness, treatment, and control of hypercholesterolemia among U.S. adults: findings from the National Health and Nutrition Examination Survey, 1999 to 2000. Circulation. 2003;107(17):2185–2189. .
    1. Gooding HC, McGinty S, Richmond TK, Gillman MW, Field AE. Hypertension awareness and control among young adults in the national longitudinal study of adolescent health. J Gen Intern Med. 2014;29(8):1098–1104. .
    1. McDonald M, Hertz RP, Unger AN, Lustik MB. Prevalence, awareness, and management of hypertension, dyslipidemia, and diabetes among United States adults aged 65 and older. J Gerontol. 2009;64(2):256–263. .
    1. Muntner P, Levitan EB, Brown TM, et al. Trends in the prevalence, awareness, treatment and control of high low density lipoprotein-cholesterol among United States adults from 1999–2000 through 2009–2010. Am J Cardiol. 2013;112(5):664–670. .
    1. Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(25 suppl 2):S1–45. .
    1. Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart disease and stroke statistics-2017 update: a report from the American Heart Association. Circulation. 2017;135(10):e146–e603. .
    1. Brown TM, Tanner RM, Carson AP, et al. Awareness, treatment, and control of LDL cholesterol are lower among U.S. adults with undiagnosed diabetes versus diagnosed diabetes. Diabetes Care. 2013;36(9):2734–2740. .
    1. Medicaid and CHIP eligibility levels. [Accessed February 24, 2017];. . Published 2016.
    1. Johnson CL, Paulose-Ram R, Ogden CL, et al. National Health and Nutrition Examination Survey: analytic guidelines, 1999–2010. Vital Health Stat 2. 2013;161:1–24.
    1. Christian JB, Bourgeois NE, Lowe KA. Cholesterol screening in U.S. adults and awareness of high cholesterol among individuals with severe hypertriglyceridemia: National Health and Nutrition Examination Survey 2001–2008. J Cardiovasc Nurs. 2015;30(1):26–34. .
    1. Fowler-Brown A, Corbie-Smith G, Garrett J, Lurie N. Risk of cardiovascular events and death–does insurance matter? J Gen Intern Med. 2007;22(4):502–507. .
    1. Kaplan GA, Keil JE. Socioeconomic factors and cardiovascular disease: a review of the literature. Circulation. 1993;88(4):1973–1998. .
    1. Mensah GA, Mokdad AH, Ford ES, Greenlund KJ, Croft JB. State of disparities in cardiovascular health in the United States. Circulation. 2005;111(10):1233–1241. .
    1. Arnold SV, Spertus JA, Tang F, et al. Statin use in outpatients with obstructive coronary artery disease. Circulation. 2011;124(22):2405–2410. .
    1. Smolderen KG, Spertus JA, Tang F, et al. Treatment differences by health insurance among outpatients with coronary artery disease: insights from the National Cardiovascular Data Registry. J Am Coll Cardiol. 2013;61(10):1069–1075. .
    1. Brooks EL, Preis SR, Hwang SJ, et al. Health insurance and cardiovascular disease risk factors. Am J Med. 2010;123(8):741–747. .
    1. American Diabetes Association. 8. Cardiovascular disease and risk management. Diabetes Care. 2015;38(suppl 1):S49–57. .
    1. Sharma S, Malarcher AM, Giles WH, Myers G. Racial, ethnic, and socioeconomic disparities in the clustering of cardiovascular risk factors. Ethn Dis. 2004;14(1):43–48.
    1. Elmer PJ, Grimm R, Jr, Laing B, et al. Lifestyle intervention: results of the Treatment of Mild Hypertension Study (TOMHS) Prev Med. 1995;24(4):378–388. .
    1. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403. .
    1. Sacks FM, Svetkey LP, Vollmer WM, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med. 2001;344(1):3–10. .
    1. Tuomilehto J, Lindstrom J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344(18):1343–1350. .
    1. Whelton SP, Chin A, Xin X, He J. Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. Ann Intern Med. 2002;136(7):493–503. .
    1. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. Hypertension. 2018;71(1):1–481. .
    1. Vinci SR, Rifas-Shiman SL, Cheng JK, Mannix RC, Gillman MW, de Ferranti SD. Cholesterol testing among children and adolescents during health visits. JAMA. 2014;311(17):1804–1807. .
    1. Fortuna RJ, Robbins BW, Halterman JS. Ambulatory care among young adults in the United States. Ann Intern Med. 2009;151(6):379–385. .

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe