Prevalence of Cardiovascular Risk Factors and Established Cardiovascular Disease Among All of Us Participants: Benchmarking Against National Estimates

Background The AoU (All of Us) Research Program aims to accelerate precision‐medicine research. To provide context for the generalizability of findings we benchmarked cardiovascular risk factors and established cardiovascular disease prevalence in AoU against nationally representative estimates. Methods We included AoU participants enrolled between May 2017 and June 2022 and the NHANES (National Health and Nutrition Examination Survey) 2017 to March 2020 cycle. The AoU Survey cohort included participants who completed the Personal and Family Health History survey (N=185 232). AoU EHR included participants with linked electronic health record (EHR) (N=287 012). We identified cardiovascular risk factors and cardiovascular disease through survey questions in AoU Survey and NHANES, and Systematized Nomenclature of Medicine codes for AoU EHR. Results AoU Survey and AoU EHR were older than NHANES (56.1±17 years and 57.6±17 years versus 47.5±18 years) with more female participants (64% and 60% versus 51.8%). Black participants were underrepresented in AoU Survey (9.1%) and overrepresented in AoU EHR (19.9%); 11.5% in NHANES. Prevalence of cardiovascular comorbidities in AoU Survey and NHANES were similar but lower in AoU Survey when age adjusted (eg, hypertension 31.7% in NHANES versus 19.7% in AoU Survey, diabetes 11.3% versus 8%). Black participants had higher unadjusted rates of hypertension, diabetes, coronary artery disease and congestive heart failure than NHANES. AoU EHR with its code‐based identification had higher unadjusted prevalence of most cardiovascular comorbidities; differences attenuated with age‐adjustment. Conclusions AoU includes more historically underrepresented groups, but representation varies by whether cohorts are defined by survey versus EHR availability. Further, disease prevalence can change based on how conditions are ascertained.