Abstract Background Declines in cardiovascular mortality have stalled in the US since 2010. There is substantial concern that pandemic-related disruptions in access to care may have worsened cardiometabolic risk factor control, especially in higher-risk adults with atherosclerotic disease (ASCVD), but little is known about these epidemiological patterns. Purpose To determine national changes in blood pressure, hemoglobin A1c levels, and total cholesterol concentrations, as well as control rates, among US adults with ASCVD 2013 and 2023. Methods We identified adults aged 20 and above with ASCVD in the National Health and Nutrition Examination Survey (NHANES, 2013-2023). Mean systolic and diastolic blood pressure, hemoglobin A1c levels, total cholesterol concentrations were evaluated in adults with ASCVD used detailed biometric and laboratory data provided in NHANES. We further examined rates of blood pressure control (130/80mmHg), glycemic control (hemoglobin A1c 7%) and total cholesterol control (200 mg/dL). Survey-weighted linear regression models were fit to determine changes over the study period. All analyses incorporated NHANES survey weights to obtain nationally representative estimates. Results In the US, there was no change in mean systolic blood pressure among adults with ASCVD between 2013-2014 and 2021-2023, but diastolic blood pressure significantly increased from 65.7 mmHg (95% CI, 63.3-68.1 mmHg) to 73.0 mmHg (72.1-73.9mmHg) over this time period (p0.001). Hemoglobin A1c remained stable from 2013 to 2023 (6.2% 6.0%-6.3% to 6.3% 6.2%-6.4%, p=0.12). In contrast, total cholesterol decreased from 174.2 mg/dL (170.4-178.0 mg/dL) to 167.8mg/dL (164.0-171.6 mg/dL) (p=0.01). Among adults with ASCVD, rates of blood pressure control decreased from 59% (53%-65%) in 2013-2014 to 52% (49%-55%) in 2021-2023 (p= 0.009, Figure), while rates of glycemic control did not significantly change (p=0.06, Figure). In contrast, rates of cholesterol control increased from 73% (69%-77%) to 79% (77%-82%) (p=0.018, Figure). Conclusions In this national study, rates of blood pressure control decreased among US adults with ASCVD between 2013 and 2023, corresponding with a rise in mean diastolic blood pressure, while cholesterol concentrations improved. Our findings highlight the urgent need for targeted interventions to improve blood pressure control among adults with ASCVD in the US.
Gong et al. (Sat,) studied this question.