Trends in Prevalence, Risk-Factors Controls and Medications in ASCVD Among US Adults, 1999-2018

Objective To characterize trends in prevalence of ASCVD, risk-factor control and medication use among adults with atherosclerotic cardiovascular disease (ASCVD), with frequent update of relevant guidelines. Patients and Methods We conducted a cross-sectional analysis of data from 55,081 adults in the National Health and Nutrition Examination Surveys (NHANES) 1999-2018. Results The age-standardized prevalence of ASCVD did not change significantly from 1999-2002 (7.9%, CI 7.1%-8.7%) to 2015-2018 (7.5%, CI 6.8%-8.3%) ( P for trend =0.18). Over 60.0% ASCVD participants had very-high risk. The percentage with blood-pressure control (<130/80 mmHg) increased from 51.2% (CI, 41.0%-61.3%) in 1999-2002 to 57.2% (CI, 48.4%-65.6%) in 2011-2014, but then declined to 52.8% (CI, 44.4%-81.3%) in 2015-2018. From 1999-2002 to 2015-2018, the percentage with lipid control (non-high-density lipoprotein cholesterol <100 mg/dL) increased from 7.0% (CI, 3.5%-12.3%) to 26.4% (CI, 16.2%-38.9%), and with glycemic control (HbA1c <7.0%) decreased from 95.0% (CI, 90.2%-97.9%) to 84.0% (CI, 75.9%-90.3%). The percentage who achieved all 3 targets was 18.6% (CI, 8.2%-33.8%) in 2015-2018. After 2014, the percentages with blood-pressure, lipid, and glycemic control decreased in very-high-risk ASCVD, but increased in not-very-high-risk ASCVD. The percentage of ASCVD participants who used statins increased from 1999-2002 to 2011-2014, but then leveled off. The percentage who used blood-pressure-lowering drugs remained largely constant, and who used glucose-lowering drugs increased. Conclusions The prevalence of ASCVD generally remained stable, with over 60.0% had very-high risk. Blood-pressure, lipid, and glycemic control decreased in very-high-risk ASCVD but increased in not-very-high-risk ASCVD after 2014.