https://www.jacc.org/doi/10.1016/j.jacc.2022.04.046 Skip to main content JACC Journals Search Search * All Journals * JACC * JACC: Asia * JACC: Advances * JACC: BTS * JACC: CardioOnc * JACC: Imaging * JACC: Interventions * JACC: Case Reports * JACC: Clinical EP * JACC: Heart Failure Quick Search anywhere Enter Search Terms[ ]Search Quick Search in Journals Enter Search Terms[ ]Search Quick Search in Journals Enter Search Terms[ ]Search Quick Search in Journals Enter Search Terms[ ]Search Quick Search in Journals Enter Search Terms[ ]Search Quick Search in Journals Enter Search Terms[ ]Search Quick Search in Journals Enter Search Terms[ ]Search Quick Search in Journals Enter Search Terms[ ]Search Quick Search in Journals Enter Search Terms[ ]Search Quick Search in Journals Enter Search Terms[ ]Search Quick Search in Journals Enter Search Terms[ ]Search ACC.org * 0 * + Register Sign In Skip main navigationClose Drawer MenuOpen Drawer Menu Home * Journals + JACC + JACC: Advances + JACC: Asia + JACC: Basic to Translational Science + JACC: CardioOncology + JACC: Cardiovascular Imaging + JACC: Cardiovascular Interventions + JACC: Case Reports + JACC: Clinical Electrophysiology + JACC: Heart Failure * Topics * Guidelines * Author Center * CME/MOC * Events * JACC Patient Care Pathways * * Journal of the American College of Cardiology * Current Issue * Just Accepted * Archives JACC Journals > JACC > Archives > Vol. 80 No. 2 Previous Next Trends and Disparities in Cardiometabolic Health Among U.S. Adults, 1999-2018 Original Investigation * Meghan O'Hearn, * Brianna N. Lauren, * John B. Wong, * David D. Kim, and * Dariush Mozaffarian Meghan O'Hearn Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA *Address for correspondence: Ms Meghan O'Hearn, Tufts Friedman School of Nutrition Science and Policy, 150 Harrison Avenue, Boston, Massachusetts 02111, USA. E-mail: E-mail Address: [email protected] . Twitter: @meghan_ohearn, @Dmozaffarian, @TuftsNutrition. Search for more papers by this author , Brianna N. Lauren Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA Search for more papers by this author , John B. Wong Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA Tufts Medical Center, Institute for Clinical Research and Health Policy Studies, Boston, Massachusetts, USA Search for more papers by this author , David D. Kim Tufts Medical Center, Institute for Clinical Research and Health Policy Studies, Boston, Massachusetts, USA Search for more papers by this author , and Dariush Mozaffarian Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA Search for more papers by this author J Am Coll Cardiol. 2022 Jul, 80 (2) 138-151 Editorial Comment: Failing Cardiovascular Health: A Population Code Blue^* Sections * Full Text * PDF * Podcast Download Citation Share on * * * Sections About Central Illustration [loader] Abstract Background Few studies have assessed U.S. cardiometabolic health trends--optimal levels of multiple risk factors and absence of clinical cardiovascular disease (CVD)--or its impact on health disparities. Objectives The purpose of this study was to investigate U.S. trends in optimal cardiometabolic health from 1999 to 2018. Methods We assessed proportions of adults with optimal cardiometabolic health, based on adiposity, blood glucose, blood lipids, blood pressure, and clinical CVD; and optimal, intermediate, and poor levels of each component among 55,081 U.S. adults in the National Health and Nutrition Examination Survey. Results In 2017-2018, only 6.8% (95% CI: 5.4%-8.1%) of U.S. adults had optimal cardiometabolic health, declining from 1999-2000 (P trend = 0.02). Among components of cardiometabolic health, the largest declines were for adiposity (optimal levels: 33.8%-24.0%; poor levels: 47.7%-61.9%) and glucose (optimal levels: 59.4%-36.9%; poor levels: 8.6%-13.7%) (P trend <0.001 for each). Optimal levels of blood lipids increased from 29.9%-37.0%, whereas poor decreased from 28.3%-14.7% (P trend <0.001). Trends over time for blood pressure and CVD were smaller. Disparities by age, sex, education, and race/ ethnicity were evident in all years, and generally worsened over time. By 2017-2018, prevalence of optimal cardiometabolic health was lower among Americans with lower (5.0% [95% CI: 2.8%-7.2%]) vs higher education (10.3% [95% CI: 7.6%-13.0%]); and among Mexican American (3.2% [95% CI: 1.4%-4.9%]) vs non-Hispanic White (8.4% [95% CI: 6.3%-10.4%]) adults. Conclusions Between 1999 and 2000 and 2017 and 2018, U.S. cardiometabolic health has been poor and worsening, with only 6.8% of adults having optimal cardiometabolic health, and disparities by age, sex, education, and race/ethnicity. These novel findings inform the need for nationwide clinical and public health interventions to improve cardiometabolic health and health equity. * 1. Lloyd-Jones D.M., Hong Y., Labarthe D., et al. "Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association's strategic Impact Goal through 2020 and beyond". Circulation 2010;121:4: 586-613. https://doi.org/10.1161/circulationaha.109.192703. CrossrefMedlineGoogle Scholar * 2. Labarthe D.R., Kubzansky L.D., Boehm J.K., Lloyd-Jones D.M., Berry J.D., Seligman M.E. "Positive cardiovascular health: a timely convergence". J Am Coll Cardiol 2016;68:8: 860-867. https: //doi.org/10.1016/j.jacc.2016.03.608. View ArticleGoogle Scholar * 3. Pool L.R., Ning H., Lloyd-Jones D.M., Allen N.B. "Trends in racial/ethnic disparities in cardiovascular health among US adults from 1999-2012". J Am Heart Assoc 2017;6:9: e006027 https: //doi.org/10.1161/JAHA.117.006027. CrossrefMedlineGoogle Scholar * 4. Caspard H., Jabbour S., Hammar N., Fenici P., Sheehan J.J., Kosiborod M. "Recent trends in the prevalence of type 2 diabetes and the association with abdominal obesity lead to growing health disparities in the USA: an analysis of the NHANES surveys from 1999 to 2014". Diabetes Obes Metab 2018;20:3: 667-671. https:// doi.org/10.1111/dom.13143. CrossrefMedlineGoogle Scholar * 5. Moore J.X., Chaudhary N., Akinyemiju T. "Metabolic syndrome prevalence by race/ethnicity and sex in the United States, National Health and Nutrition Examination Survey, 1988-2012". Prev Chronic Dis 2017;14:E24. https://doi.org/10.5888/ pcd14.160287. CrossrefMedlineGoogle Scholar * 6. O'Hearn M., Liu J., Cudhea F., Micha R., Mozaffarian D. "Coronavirus disease 2019 hospitalizations attributable to cardiometabolic conditions in the United States: a comparative risk assessment analysis". J Am Heart Assoc 2021;10:5: e019259 https://doi.org/10.1161/jaha.120.019259. MedlineGoogle Scholar * 7. He J., Zhu Z., Bundy J.D., Dorans K.S., Chen J., Hamm L.L. "Trends in cardiovascular risk factors in US adults by race and ethnicity and socioeconomic status, 1999-2018". JAMA 2021;326:13: 1286-1298. https://doi.org/10.1001/jama.2021.15187. CrossrefMedlineGoogle Scholar * 8. Menke A., Casagrande S., Geiss L., Cowie C.C. "Prevalence of and trends in diabetes among adults in the United States, 1988-2012". JAMA 2015;314:10: 1021-1029. https://doi.org/10.1001/ jama.2015.10029. CrossrefMedlineGoogle Scholar * 9. Palmer M.K., Toth P.P. "Trends in lipids, obesity, metabolic syndrome, and diabetes mellitus in the United States: an NHANES analysis (2003-2004 to 2013-2014)". Obesity 2019;27:2: 309-314. https://doi.org/10.1002/oby.22370. CrossrefMedlineGoogle Scholar * 10. Sidney S., Quesenberry C.P., Jaffe M.G., et al. "Recent trends in cardiovascular mortality in the United States and public health goals". JAMA Cardiol 2016;1:5: 594-599. https:// doi.org/10.1001/jamacardio.2016.1326. CrossrefMedlineGoogle Scholar * 11. Shah N.S., Lloyd-Jones D.M., O'Flaherty M., et al. "Trends in cardiometabolic mortality in the United States, 1999-2017". JAMA 2019;322:8: 780-782. https://doi.org/10.1001/jama.2019.9161. CrossrefMedlineGoogle Scholar * 12. Lloyd-Jones D.M., Hong Y., Labarthe D., et al. "Defining and setting national goals for cardiovascular health promotion and disease reduction". Circulation 2010;121:4: 586-613. https:// doi.org/10.1161/CIRCULATIONAHA.109.192703. CrossrefMedlineGoogle Scholar * 13. Araneta M.R.G., Kanaya A.M., Hsu W.C., et al. "Optimum BMI cut points to screen Asian Americans for type 2 diabetes". Diabetes Care 2015;38:5: 814-820. https://doi.org/10.2337/ dc14-2071. CrossrefMedlineGoogle Scholar * 14. Grundy S.M., Cleeman J.I., Daniels S.R., et al. "Diagnosis and management of the metabolic syndrome". Circulation 2005; 112:17: 2735-2752. https://doi.org/10.1161/ CIRCULATIONAHA.105.169404. CrossrefMedlineGoogle Scholar * 15. Centers for Disease Control and Prevention: National Center for Health Statistics. "2010. National Health and Nutrition Examination Survey: 2001-2002 data documentation, codebook, and frequencies. Choesterol - total, HDL, LDL triglycerides, second exam". https://wwwn.cdc.gov/Nchs/Nhanes/2001-2002/L13_2_B.htm. Accessed June 27, 2021. Google Scholar * 16. Singh G.M., Danaei G., Farzadfar F., et al. "The age-specific quantitative effects of metabolic risk factors on cardiovascular diseases and diabetes: a pooled analysis". PLoS ONE 2013;8:7: e65174 https://doi.org/10.1371/journal.pone.0065174. CrossrefGoogle Scholar * 17. Mozaffarian D. "Dietary and policy priorities for cardiovascular disease, diabetes, and obesity: a comprehensive review". Circulation 2016;133:2: 187-225. https://doi.org/10.1161 /circulationaha.115.018585. CrossrefMedlineGoogle Scholar * 18. "American Diabetes Association. Dyslipidemia management in adults with diabetes". Diabetes Care 2004;27:suppl 1: s68-s71. https://doi.org/10.2337/diacare.27.2007.S68. MedlineGoogle Scholar * 19. Hirode G., Wong R.J. "Trends in the prevalence of metabolic syndrome in the United States, 2011-2016". JAMA 2020;323:24: 2526-2528. https://doi.org/10.1001/jama.2020.4501. CrossrefMedlineGoogle Scholar * 20. Nuru-Jeter A.M., Michaels E.K., Thomas M.D., Reeves A.N., Thorpe R.J., LaVeist T.A. "Relative roles of race versus socioeconomic position in studies of health inequalities: a matter of interpretation". Annu Rev Public Health 2018; 39:169-188. https://doi.org/10.1146/ annurev-publhealth-040617-014230. CrossrefMedlineGoogle Scholar * 21. Walker R.J., Strom Williams J., Egede L.E. "Influence of race, ethnicity and social determinants of health on diabetes outcomes". Am J Med Sci 2016;351:4: 366-373. https://doi.org/ 10.1016/j.amjms.2016.01.008. CrossrefMedlineGoogle Scholar * 22. Cuevas A.G., Chen R., Slopen N., et al. "Assessing the role of health behaviors, socioeconomic status, and cumulative stress for racial/ethnic disparities in obesity". Obesity (Silver Spring) 2020;28:1: 161-170. https://doi.org/10.1002/oby.22648. CrossrefMedlineGoogle Scholar * 23. National Academies of Sciences, Engineering, and Medicine. "Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation's Health". Washington, DC: The National Academies Press, 2019. https://nap.nationalacademies.org /catalog/25467/ integrating-social-care-into-the-delivery-of-health-care-moving. Google Scholar * 24. Mozaffarian D., Angell S.Y., Lang T., Rivera J.A. "Role of government policy in nutrition-barriers to and opportunities for healthier eating". BMJ 2018;361:k2426. https://doi.org/10.1136/ bmj.k2426. CrossrefMedlineGoogle Scholar * 25. Gruss S.M., Nhim K., Gregg E., Bell M., Luman E., Albright A. "Public health approaches to type 2 diabetes prevention: the US National Diabetes Prevention Program and beyond". Curr Diabetes Rep 2019;19:9: 78. https://doi.org/10.1007/s11892-019-1200-z. CrossrefMedlineGoogle Scholar * 26. Downer S., Berkowitz S.A., Harlan T.S., Olstad D.L., Mozaffarian D. "Food is medicine: actions to integrate food and nutrition into healthcare". BMJ 2020;369:m2482. https://doi.org/ 10.1136/bmj.m2482. CrossrefMedlineGoogle Scholar * 27. Centers for Disease Control and Prevention. "Division for Heart Disease and Stroke Prevention. (2020). National Hypertension Control Roundtable". https://www.cdc.gov/dhdsp/ programs/hypertension-roundtable.htm. Accessed June 27, 2021. Google Scholar * 28. Lee Y., Mozaffarian D., Sy S., et al. "Health impact and cost-effectiveness of volume, tiered, and absolute sugar content sugar-sweetened beverage tax policies in the United States: a microsimulation study". Circulation 2020;142:6: 523-534. https:// doi.org/10.1161/circulationaha.119.042956. CrossrefMedlineGoogle Scholar * 29. Kenney E.L., Mozaffarian R.S., Long M.W., et al. "Limiting television to reduce childhood obesity: cost-effectiveness of five population strategies". Child Obes 2021;17:7: 442-448. https://doi.org/10.1089/chi.2021.0016. MedlineGoogle Scholar * 30. Dixon B.N., Ugwoaba U.A., Brockmann A.N., Ross K.M. "Associations between the built environment and dietary intake, physical activity, and obesity: a scoping review of reviews". Obes Rev 2021;22:4: e13171 https://doi.org/10.1111/obr.13171. CrossrefMedlineGoogle Scholar * 31. Mande J., Willett W., Auerbach J., et al. "2020. Report of the 50th Anniversary of the White House Conference on Food, Nutrition, and Health: honoring the past, taking actions for our future. Boston, MA". https://sites.tufts.edu/ foodnutritionandhealth2019/. Accessed June 26, 2021. Google Scholar * 32. Fleischhacker S.E., Woteki C.E., Coates P.M., et al. "Strengthening national nutrition research:rationale and options for a new coordinated federal research effort and authority". Am J Clin Nutr 2020;112:3: 721-769. https://doi.org/10.1093/ajcn/ nqaa179. CrossrefMedlineGoogle Scholar * 33. Pearson-Stuttard J., Kypridemos C., Collins B., et al. "Estimating the health and economic effects of the proposed US Food and Drug Administration voluntary sodium reformulation: microsimulation cost-effectiveness analysis". PLoS Med 2018;15:4: e1002551 https://doi.org/10.1371/journal.pmed.1002551. CrossrefMedlineGoogle Scholar * 34. US Government Accountability Office. "2021. Chronic health conditions: federal strategy needed to coordinate diet-related efforts". https://www.gao.gov/assets/gao-21-593.pdf. Accessed June 26, 2021. Google Scholar * 35. Shin D., Kongpakpaisarn K., Bohra C. "Trends in the prevalence of metabolic syndrome and its components in the United States 2007-2014". Int J Cardiol 2018;259:216-219. https:// doi.org/10.1016/j.ijcard.2018.01.139. CrossrefMedlineGoogle Scholar * 36. Araujo J., Cai J., Stevens J. "Prevalence of optimal metabolic health in American adults: National Health and Nutrition Examination Survey 2009-2016". Metab Syndr Relat Disord 2019;17:1: 46-52. https://doi.org/10.1089/met.2018.0105. CrossrefMedlineGoogle Scholar * 37. American Diabetes Association. "2021. Understanding A1c: diagnosis". https://www.diabetes.org/a1c/diagnosis. Accessed June 16, 2021. Google Scholar * 38. Calling S., Johansson S.-E., Wolff M., Sundquist J., Sundquist K. "The ratio of total cholesterol to high density lipoprotein cholesterol and myocardial infarction in women's health in the Lund area (WHILA): a 17-year follow-up cohort study". BMC Cardiovasc Disord 2019;19:1: 239. https://doi.org/ 10.1186/s12872-019-1228-7. CrossrefMedlineGoogle Scholar * 39. Grundy S.M., Stone N.J., Bailey A.L., et al. "2018 AHA/ACC/ AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines". J Am Coll Cardiol 2019;73:24: e285-e350. https://doi.org/10.1016/j.jacc.2018.11.003. View ArticleGoogle Scholar * 40. Unger T., Borghi C., Charchar F., et al. "2020 International Society of Hypertension Global Hypertension Practice Guidelines". Hypertension 2020;75:6: 1334-1357. https://doi.org/10.1161/ HYPERTENSIONAHA.120.15026. CrossrefMedlineGoogle Scholar * Multimedia * References * Related * Details * * Cited By Failing Cardiovascular Health Journal of the American College of Cardiology, 80(2): 152-154, Online publication date: 12-Jul-2022. --------------------------------------------------------------------- [podcast-th] Trends and Disparities in Cardiometabolic Health among U.S. Adults, 1999-2018 Valentin Fuster July 4, 2022 Your browser does not support the audio element. Keywords * metabolic syndrome * health disparities * obesity * cardiometabolic health * diabetes --------------------------------------------------------------------- PDF Download --------------------------------------------------------------------- Information Copyright (c) 2022, American College of Cardiology Foundation. Published by Elsevier --------------------------------------------------------------------- Article History * ReceivedJanuary 26, 2022 * AcceptedApril 12, 2022 * Published onlineJuly 4, 2022 Loading Close Figure Viewer Browse All FiguresReturn to FigureChange zoom level [ ]Zoom inZoom out Previous FigureNext Figure Caption * Journal of the American College of Cardiology + Home + Current Issue + Just Accepted + Archives + About + Editor-in-Chief Biography + Editorial Board * JACC Journals + About the Journals + JACC + JACC: Advances + JACC: Asia + JACC: Basic to Translational Science + JACC: CardioOncology + JACC: Cardiovascular Imaging + JACC: Cardiovascular Interventions + JACC: Case Reports + JACC: Clinical Electrophysiology + JACC: Heart Failure * JACC International + About + JACC Chinese + JACC Portuguese + JACC Spanish * Resources + Advertising + Help + Policies + Publication Committee + Reprints / Permissions * Stay Connected + Email Alerts + Events + Contact Us + Social Media + Subscribe * Authors & Reviewers + For Authors + For Reviewers + FAQ + Operating Policies * Explore + CME/MOC + Guidelines + JACC Edge Newsletter + Podcasts + Topics & Collections + Videos JACC Journals American College of Cardiology Heart House * 2400 N.St. NW * Washington, DC 20037 * Email: [email protected] * Phone: (202) 375-6000, ext. 5603 * Toll Free: (800) 253-4636, ext.5603 * Fax: (202) 375-7000 Follow us + + + + + + Transforming Education to Knowledge * ACC * Accreditation Services * Annual Scientific Session * Cardiosmart * CV Quality * JACC Journals * MedAxiom * NCDR Privacy Policy | Registered User Agreement | Terms of Service | Cookie Policy | Media (c) 2022 American College of Cardiology Foundation. 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