State Key Laboratory for Innovation and Transformation of Luobing Theory, Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
Department of Cardiology, Gusu School, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Nanjing Medical University, 26 Daoqian Street, Suzhou, 215002, China.
BMC Med. 2024 Jun 13;22(1):245. doi: 10.1186/s12916-024-03453-5.
Early-life cardiovascular risk factors (CVRFs) are known to be associated with target organ damage during adolescence and premature cardiovascular morbidity and mortality during adulthood. However, contemporary data describing whether the prevalence of CVRFs and treatment and control rates have changed are limited. This study aimed to examine the temporal trends in the prevalence, treatment, and control of CVRFs among US adolescents over the past 2 decades.
This is a serial cross-sectional study using data from nine National Health and Nutrition Examination Survey cycles (January 2001-March 2020). US adolescents (aged 12 to 19 years) with information regarding CVRFs (including hypertension, elevated blood pressure [BP], diabetes, prediabetes, hyperlipidemia, obesity, overweight, cigarette use, inactive physical activity, and poor diet quality) were included. Age-adjusted trends in CVRF prevalence, treatment, and control were examined. Joinpoint regression analysis was performed to estimate changes in the prevalence, treatment, and control over time. The variation by sociodemographic characteristics were also described.
A total of 15,155 US adolescents aged 12 to 19 years (representing ≈ 32.4 million people) were included. From 2001 to March 2020, there was an increase in the prevalence of prediabetes (from 12.5% [95% confidence interval (CI), 10.2%-14.9%] to 37.6% [95% CI, 29.1%-46.2%]) and overweight/obesity (from 21.1% [95% CI, 19.3%-22.8%] to 24.8% [95% CI, 21.4%-28.2%]; from 16.0% [95% CI, 14.1%-17.9%] to 20.3% [95% CI, 17.9%-22.7%]; respectively), no improvement in the prevalence of elevated BP (from 10.4% [95% CI, 8.9%-11.8%] to 11.0% [95% CI, 8.7%-13.4%]), diabetes (from 0.7% [95% CI, 0.2%-1.2%] to 1.2% [95% CI, 0.3%-2.2%]), and poor diet quality (from 76.1% [95% CI, 74.0%-78.2%] to 71.7% [95% CI, 68.5%-74.9%]), and a decrease in the prevalence of hypertension (from 8.1% [95% CI, 6.9%-9.4%] to 5.5% [95% CI, 3.7%-7.3%]), hyperlipidemia (from 34.2% [95% CI, 30.9%-37.5%] to 22.8% [95% CI, 18.7%-26.8%]), cigarette use (from 18.0% [95% CI, 15.7%-20.3%] to 3.5% [95% CI, 2.0%-5.0%]), and inactive physical activity (from 83.0% [95% CI, 80.7%-85.3%] to 9.5% [95% CI, 4.2%-14.8%]). Sex and race/ethnicity affected the evolution of CVRF prevalence differently. Whilst treatment rates for hypertension and diabetes did not improve significantly (from 9.6% [95% CI, 3.5%-15.8%] to 6.0% [95% CI, 1.4%-10.6%]; from 51.0% [95% CI, 23.3%-78.7%] to 26.5% [95% CI, 0.0%-54.7%]; respectively), BP control was relatively stable (from 75.7% [95% CI, 56.8%-94.7%] to 73.5% [95% CI, 40.3%-100.0%]), while glycemic control improved to a certain extent, although it remained suboptimal (from 11.8% [95% CI, 0.0%-31.5%] to 62.7% [95% CI, 62.7%-62.7%]).
From 2001 to March 2020, although prediabetes and overweight/obesity increased, hypertension, hyperlipidemia, cigarette use, and inactive physical activity decreased among US adolescents aged 12 to 19 years, whereas elevated BP, diabetes, and poor diet quality remained unchanged. There were disparities in CVRF prevalence and trends across sociodemographic subpopulations. While treatment and control rates for hypertension and diabetes plateaued, BP control were stable, and improved glycemic control was observed.
已知儿童期心血管风险因素（CVRF）与青春期靶器官损伤以及成年期心血管发病和死亡率过早有关。然而，目前描述 CVRF 的流行率、治疗和控制率是否发生变化的当代数据有限。本研究旨在研究过去 20 年来美国青少年中 CVRF 的流行率、治疗和控制的时间趋势。
这是一项使用九个全国健康和营养检查调查周期（2001 年 1 月至 2020 年 3 月）数据的连续横断面研究。包括有高血压、血压升高、糖尿病、前驱糖尿病、血脂异常、肥胖、超重、吸烟、体力活动不足和饮食质量差等 CVRF 信息的美国 12 至 19 岁青少年。研究检查了 CVRF 流行率、治疗和控制的年龄调整趋势。使用 Joinpoint 回归分析评估了随时间变化的流行率、治疗和控制变化。还描述了社会人口统计学特征的差异。
共纳入了 15155 名年龄在 12 至 19 岁的美国青少年（代表 ≈3240 万人）。从 2001 年至 2020 年 3 月，前驱糖尿病的流行率增加（从 12.5%[95%置信区间（CI），10.2%-14.9%]增加到 37.6%[95% CI，29.1%-46.2%]）和超重/肥胖（从 21.1%[95% CI，19.3%-22.8%]增加到 24.8%[95% CI，21.4%-28.2%]；从 16.0%[95% CI，14.1%-17.9%]增加到 20.3%[95% CI，17.9%-22.7%]），血压升高的流行率没有改善（从 10.4%[95% CI，8.9%-11.8%]增加到 11.0%[95% CI，8.7%-13.4%]），糖尿病（从 0.7%[95% CI，0.2%-1.2%]增加到 1.2%[95% CI，0.3%-2.2%]）和饮食质量差（从 76.1%[95% CI，74.0%-78.2%]增加到 71.7%[95% CI，68.5%-74.9%]），高血压的流行率降低（从 8.1%[95% CI，6.9%-9.4%]降低到 5.5%[95% CI，3.7%-7.3%]），血脂异常（从 34.2%[95% CI，30.9%-37.5%]降低到 22.8%[95% CI，18.7%-26.8%]），吸烟（从 18.0%[95% CI，15.7%-20.3%]降低到 3.5%[95% CI，2.0%-5.0%]）和体力活动不足（从 83.0%[95% CI，80.7%-85.3%]降低到 9.5%[95% CI，4.2%-14.8%]）。性别和种族/民族对 CVRF 流行率的演变有不同的影响。虽然高血压和糖尿病的治疗率没有显著改善（从 9.6%[95% CI，3.5%-15.8%]增加到 6.0%[95% CI，1.4%-10.6%]；从 51.0%[95% CI，23.3%-78.7%]增加到 26.5%[95% CI，0.0%-54.7%]），但血压控制相对稳定（从 75.7%[95% CI，56.8%-94.7%]增加到 73.5%[95% CI，40.3%-100.0%]），而血糖控制有所改善，尽管仍不理想（从 11.8%[95% CI，0.0%-31.5%]增加到 62.7%[95% CI，62.7%-62.7%]）。
从 2001 年至 2020 年 3 月，尽管前驱糖尿病和超重/肥胖增加，但美国 12 至 19 岁青少年的高血压、血脂异常、吸烟和体力活动不足减少，而血压升高、糖尿病和饮食质量差保持不变。社会人口统计学亚群之间存在 CVRF 流行率和趋势的差异。虽然高血压和糖尿病的治疗和控制率停滞不前，但血压控制稳定，血糖控制改善。
