National Center for Health StatisticsDivision of Health and Nutrition Examination Surveys

Monitoring cardiovascular risk factors in the US

populationCynthia Ogden, PhD, MRP & Cheryl Fryar, MSPH

U.S. population-based estimates of:

• Health conditions

• Awareness, treatment and control of selected diseases

• Environmental exposures

• Nutritional status and diet behaviors

Goals of National Health and Nutrition Examination Surveys

(NHANES)

National Health and Nutrition Examination Surveys

NHES I 1960-62 18-79 yearsNHES II 1963-65 6-11 yearsNHES III 1966-70 12-17 yearsNHANES I 1971-75 1-74 yearsNHANES II 1976-80 6 mo.-74 yearsHHANES 1982-84 6 mo.-74 yearsNHANES III 1988-94 2 mo. +

Survey Dates Ages

NHANES 1999-2000 All agesNHANES 2001-2002 All agesNHANES 2003-2004 All agesNHANES 2005-2006 All agesNHANES 2007-2008 All agesNHANES 2009-2010 All agesNHANES 2011-2012 All ages

Survey Dates Ages

OP96S025

National Health and Nutrition Examination Surveys

Sample• US Civilian, non-institutionalized

population

• All ages

• Oversample:–African Americans–Asian Americans–Hispanics/Latinos–Older persons aged 60+–Low income whites

Stage 4SPs

Stage 1Counties

Stage 2Segments

Stage 3Households

• Broad range of health conditions

• Health-related behaviors and exposures

• Health care utilization

• Health insurance

• Prescription medications

• Dietary supplements

Interview

Mobile examination center

Cardiovascular health

Laboratory

Mobile exam center laboratory

• Complete blood count• Pregnancy test• Specimen processing

Blood, urine, water, swabs, wipes300 assays24 laboratories

Laboratory tests

• Nutritional biomarkers• Hormone tests• Diabetes• Lipids, CRP• Biochemistry profile• Infectious diseases• Environmental exposures

NHANES response rates1999-2010

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 201060

65

70

75

80

85

90

InterviewedExamined

%

Both sexes Men Women0

5

10

15

20

25

30

13.412.2

14.3 313.511.4

15.4 3

10.3 10.2 10.3

14.5 2 15.4 1,213.2

All race ethnic groups NH whiteNH black Hispanics

Greater than or equal to 240 mg/dL; 1 Significantly different from non-Hispanic white; 2 Significantly different from non-Hispanic black; 3 Significantly different from men in the same race/ethnicity group. SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey. Carroll et al NCHS Data Brief 2012

Percent of adults with high serum total cholesterol, US, 2009-2010

Percent

Trends in the percent of adults with high serum total cholesterol, US, 1999-2010

40-59 years 60 years and older

1999-2000

2001-2002

2003-2004

2005-2006

2007-2008

2009-2010

0

5

10

15

20

25

30

35

Men Women HP 2010

1999-2000

2001-2002

2003-2004

2005-2006

2007-2008

2009-2010

0

5

10

15

20

25

30

35

Men Women HP 2010

† A serum total cholesterol greater than or equal to 240 mg/dL *Significant decreasing trends (p<0.005) NOTES: HP 2010 = Healthy People 2010 Objective (17%). SOURCE:CDC/NCHS, National Health and Nutrition Examination Survey,.

***

Percent Percent

Both sexes Men Women0

5

10

15

20

25

30

35

40

21.3

31.4

11.9 3

21.3

31.9

11 3

16.4 1

20.7 1

12.93

24.8 2

35.1 2

14.6 3

All race ethnic groups NH WhiteNH black Hispanics

†Less than 40 mg/dL 1 Significantly different from non-Hispanic white 2 Significantly different from non-Hispanic black 3 Significantly different from men in the same race/ethnicity group SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey

Percent of adults with low HDL, US, 2009-2010

Percent

Analysis Linking Health Insurance Questionnaire and Exam Data

NHANES and Million Hearts

Status of the ABCS

Aspirin People at increased risk of cardiovascular disease who are taking aspirin

47%

Blood pressure

People with hypertension who have adequately controlled blood pressure

46%

Cholesterol People with high cholesterol who have adequately controlled hyperlipidemia

33%

Smoking People trying to quit smoking who get help 23%

Source: MMWR: Million Hearts: Strategies to Reduce the Prevalence of Leading Cardiovascular Disease Risk Factors --- United States, 2011, Early Release, Vol. 60

The 3 Risk Factors

Uncontrolled High Blood Pressure

Measured systolic blood pressure ≥140 mm Hg or a diastolic blood pressure ≥90 mm Hg, based on the average of up to three measurements

Persons may or may not have been taking medication  

Uncontrolled High LDL-Cholesterol

Measured levels of LDL cholesterol above the treatment goals established by the National Cholesterol Education Program (NCEP) Adult Treatment Panel-III (ATP-III) guidelines: <160 mg/dL, <130 mg/dL, and <100 mg/dL for low-, intermediate-, and high-risk groups, respectively.

Persons may or may not have been taking medication. 

Smoker

 Person reporting that they smoked at least 100 cigarettes in their lifetime and now smoke every day or some days, or a measured serum cotinine (the primary nicotine metabolite) level >10 ng/mL.

1999-2000

2001-2002

2003-2004

2005-2006

2007-2008

2009-2010

0

20000000

40000000

60000000

80000000

100000000

120000000

140000000

20

30

40

50

60

70

80

90

100

109,096,467109,478,535111,305,348108,417,722107,342,094102,510,405

57.8 55.354.2 51.5 49.7 46.5

Mil

lion

s

Per

cent

Prevalence and number of US adults who smoke or have uncontrolled high BP or uncontrolled

high cholesterol

Linear trend in prevalence significant (p<0.01) after adjustment for sex, age group, race/ethnicity, and poverty-income ratio. MMWR Sept 2011. Updated with 2009-10 data.

Percentage of US adults with at least 1 risk factor

Total 20-39 years 40-59 years 60 + years0

10

20

30

40

50

60

46.541.8

47.0

53.751.648.6

53.8 53.4

41.2

34.4

40.5

53.9

Both Male Female

Percent

Source: CDC/NCHS, National Health and Nutrition Examination Survey 2009-2010

Source: National Health and Nutrition Examination Surveys; Fryar et al 2012 NCHS Data Brief

Percentage of men with at least 1 risk factor, by age:

US, 1999-2010

1999-2000 2001-2002 2003-2004 2005-2006 2007-2008 2009-201030

35

40

45

50

55

60

65

70

75

80

54.551.9

54 55 56

48.6

71.4

63.8 62.6

57.7

57.9

53.8

73.7

70.1 70.8

64.4

54.9

53.4

20-39 y 40-59 y 60+ y

Perc

ent

Source: National Health and Nutrition Examination Surveys; Fryar et al 2012 NCHS Data Brief

Percentage of women with at least 1 risk factor, by age: US, 1999-2010

1999-2000 2001-2002 2003-2004 2005-2006 2007-2008 2009-201030

35

40

45

50

55

60

65

70

75

80

38.7

34.136.1 37.1 31.1

34.4

44.7

52.7

48.1

42.8

46.1

40.5

78.3

73.2

65.3

61.2

57.153.9

20-39 y 40-59 y 60+ y

Perc

ent

1999-2000

2001-2002

2003-2004

2005-2006

2007-2008

2009-2010

20-39 40-59 60+

1999-2000 2001-2002 2003-2004 2005-2006 2007-2008 2009-201030

40

50

60

70

80

90

100

Men Women

Source: National Health and Nutrition Examination Surveys; Fryar et al 2012 NCHS Data Brief

Percentage of adults with at least 1 risk factor, by sex and age: US, 1999-2010

• 1999-2010 decrease

Men 40-59 and 60+ years Women 60+ years

• Men more likely

• Older women more likely than younger

Sex specific results

Source: National Health and Nutrition Examination Surveys; Fryar et al 2012 NCHS Data Brief

Percentage of adults with at least 1 risk factor, by race/ethnicity: US, 1999-2010

1999-2000 2001-2002 2003-2004 2005-2006 2007-2008 2009-20100

10

20

30

40

50

60

70

58.154.8 54.6

52.649.5

46.9

62.2 63.759.9

55.2

61.657.8

51.7 51.4 50.4

43.2 44.6 44.6

non-Hispanic white non-Hispanic black Mexican American

Percent

• 1999-2010 decrease

Non-Hispanic white adults Mexican American adults

• Non-Hispanic black adults more likely

1 12

Race/ethnicity specific results

Source: National Health and Nutrition Examination Surveys; Fryar et al 2012 NCHS Data Brief

Percentage of adults with at least 1 risk factor, by poverty level: US, 1999-2010

1999-2000 2001-2002 2003-2004 2005-2006 2007-2008 2009-20100

10

20

30

40

50

60

70

80

70.265.5

63.259.8

66.4

60.662.7 61.6 59.9

56.8

49.547.2

49.546 45.7 44 42.6

37.9

<130% poverty 130-350% poverty >350% poverty

Percent

• 1999-2010 decrease

All income groups

• Lowest income adults more at likely

1,21,2 1,2PIR specific results

Source: National Health and Nutrition Examination Surveys; Fryar et al 2012 NCHS Data Brief

Percentage of adults who smoke: US, 1999-2010

1999-2000 2001-2002 2003-2004 2005-2006 2007-2008 2009-20100

10

20

30

40

50

60

70

28.3 28.330.5 31.1

2825.1Pe

rcen

t

Source: National Health and Nutrition Examination Surveys; Fryar et al 2012 NCHS Data Brief

Percentage of adults with uncontrolled high LDL cholesterol: US, 1999-2010

1999-2000 2001-2002 2003-2004 2005-2006 2007-2008 2009-20100

10

20

30

40

50

60

70

32.629.1

24.621.9 21.9 23.3

Perc

ent

Source: National Health and Nutrition Examination Surveys; Fryar et al 2012 NCHS Data Brief

Percentage of adults with uncontrolled high blood pressure: US, 1999-2010

1999-2000 2001-2002 2003-2004 2005-2006 2007-2008 2009-20100

10

20

30

40

50

60

70

19.4 18.7 17.2 15.813.2 11.8

Perc

ent

Source: National Health and Nutrition Examination Surveys; Fryar et al 2012 NCHS Data Brief

Percentage of adults with at least 1 risk factor:

US, 1999-2010

1999-2000 2001-2002 2003-2004 2005-2006 2007-2008 2009-20100

10

20

30

40

50

60

70

57.855.3 54.2

51.549.7

46.5

Perc

ent

• 1999-2010 decrease

Uncontrolled high blood pressure

Uncontrolled high LDL cholesterol

1 1 1

Individual risk factors

NHANES and CVD risk factors

• NHANES resource for monitoring trends

• Percent of US adults with 1+ risk factorDecrease 1999-2010 Not among African Americans Men, older adults, African Americans, lower

income adults more likely to have risk factors

• Percent of US adults with Individual risk factors Decrease in uncontrolled high blood

pressure and uncontrolled high LDL cholesterol

No significant change in smoking

Thank you to our colleagues

Margaret Carroll, MSPHTe-Ching Chen, PhD

Xianfen Li, MS

Disclaimer

The findings and conclusions in this presentation are those of the author and not necessarily of CDC