Chobufo Muchi Ditah, Singla Atul, Rahman Ebad Ur, Michos Erin D, Whelton Paul K, Balla Sudarshan
Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, WV 26505, USA.
Department of Medicine, Kaweah Health Medical Center, Visalia, CA 93291, USA.
Eur J Prev Cardiol. 2022 Dec 21;29(18):2289-2300. doi: 10.1093/eurjpc/zwac161.
Atherosclerotic cardiovascular diseases are a significant cause of disability and mortality. Study of trends in cardiovascular risk at a population level helps understand the overall cardiovascular health and the impact of primary prevention efforts.
To assess trends in the estimated 10-year atherosclerotic cardiovascular disease (ASCVD) risk among U.S. adults from 1999-2000 to 2017-18 with no established cardiovascular disease (CVD).
Serial cross-sectional analysis of National Health and Nutrition Examination Survey (NHANES) data from 1999-2000 to 2017-18 (10 cycles), including 24 022 US adults aged 40-79 years with no reported ASCVD. ASCVD risk was assessed using the pooled cohort equations (PCEs). There was a significant temporal decline in the mean 10-year ASCVD risk from 13.5% (95% CI, 12.5-14.4) in 1999-2000 to 11.1% (10.5-11.7) in 2011-12 (Ptrend < 0.001) and to 12.0% (11.3-12.7) in 2017-2018 (overall Ptrend = 0.001), with the mean ASCVD risk score remaining stable from 2013-14 through 2017-2018 (Ptrend = 0.056). A declining trend in ASCVD risk was noted in females, non-Hispanic Blacks and those with income <3 times the poverty threshold with Ptrend of <0.001, 0.002, and 0.007, respectively. Mean total cholesterol and prevalence of smokers showed a downward trend (Ptrend <0.001 for both), whereas type 2 diabetes and mean BMI showed an upward trend (Ptrend < 0.001 for both).
The 20-year trend of ASCVD risk among NHANES participants 40-79 years, as assessed by the use of PCE, showed a non-linear downward trend from 1999-2000 to 2017-18. The initial and significant decline in estimated ASCVD risk from 1999-2000 to 2011-12 subsequently stabilized, with no significant change from 2013-14 to 2017-18. Mean BMI and prevalence of diabetes mellitus increased while mean serum cholesterol levels and prevalence of smoking declined during the study period. Our findings support invigoration of efforts aimed at prevention of CVD, including primordial prevention of CVD risk factors.
动脉粥样硬化性心血管疾病是导致残疾和死亡的重要原因。在人群层面研究心血管风险趋势有助于了解整体心血管健康状况以及一级预防措施的影响。
评估1999 - 2000年至2017 - 2018年期间美国无心血管疾病（CVD）的成年人中，估计的10年动脉粥样硬化性心血管疾病（ASCVD）风险的趋势。
对1999 - 2000年至2017 - 2018年（10个周期）的国家健康与营养检查调查（NHANES）数据进行系列横断面分析，纳入24022名40 - 79岁且未报告ASCVD的美国成年人。使用合并队列方程（PCEs）评估ASCVD风险。10年ASCVD平均风险从1999 - 2000年的13.5%（95%CI，12.5 - 14.4）显著下降至2011 - 12年的11.1%（10.5 - 11.7）（Ptrend < 0.001），并在2017 - 2018年降至12.0%（11.3 - 12.7）（总体Ptrend = 0.001），ASCVD风险评分均值在2013 - 14年至2017 - 2018年保持稳定（Ptrend = 0.056）。女性、非西班牙裔黑人以及收入低于贫困线3倍的人群中ASCVD风险呈下降趋势，Ptrend分别<0.001、0.002和0.007。总胆固醇均值和吸烟者患病率呈下降趋势（两者Ptrend均<0.001），而2型糖尿病及平均体重指数呈上升趋势（两者Ptrend均<0.001）。
通过PCE评估，40 - 79岁NHANES参与者中ASCVD风险的20年趋势显示，从1999 - 2000年至2017 - 2018年呈非线性下降趋势。1999 - 2000年至2011 - 12年估计的ASCVD风险最初显著下降，随后趋于稳定，2013 - 14年至2017 - 2018年无显著变化。在研究期间，平均体重指数和糖尿病患病率上升，而血清胆固醇水平均值和吸烟患病率下降。我们的研究结果支持加强旨在预防CVD的努力，包括对CVD危险因素的原级预防。
