Key result
US adult obesity rates rose ~23% higher per decade alongside diverging cardiovascular risk trends.
Why the study?
Cardiovascular risk factors have changed in the United States, but trends in their prevalence, management, and predicted risk through the post-pandemic period remained incompletely characterized.
Cross-Sectional (n=60,199)
Yes
Between 1999 and 2023 among US adults, improvements in smoking, lipid levels, and mean blood pressure were counterbalanced by rising obesity and diabetes, recent reversals in blood pressure and glycemic control, and an increasing predicted risk of heart failure that now equals predicted ASCVD risk.
Answers are grounded in this paper and cite their sources.
US cardiometabolic trends may warrant intensified prevention efforts; leaves open optimal strategies to address diverging predicted HF versus ASCVD risks.
Background: Cardiovascular risk factors have changed in the United States, but trends in prevalence, management, and predicted risk through the post-pandemic period remain incompletely characterized. Methods: We analyzed 11 National Health and Nutrition Examination Survey (NHANES) periods (1999-2000 through 2021-2023) among 60,199 nonpregnant adults aged 20 years. Survey-weighted regression assessed age-standardized trends, subgroup differences, and measurement-change sensitivity. We assessed awareness, treatment, and control of hypertension, dyslipidemia, and diabetes. PREVENT equations estimated 10- and 30-year risks among adults without self-reported cardiovascular disease (CVD). Results: Obesity increased from 47.4% to 57.2% (odds ratio [OR] per decade, 1.23; 95% CI, 1.16-1.30), with class III obesity more than doubling (4.7% to 9.7%). Diabetes increased from 8.2% to 12.7% (OR, 1.26; 95% CI, 1.19-1.34), while current smoking declined from 24.4% to 14.9% (OR, 0.76; 95% CI, 0.71-0.81). Hypertension, dyslipidemia, chronic kidney disease, and prior CVD showed no significant linear trends, although mean systolic blood pressure (BP) (124.2 to 120.2 mm Hg) and total cholesterol (203.6 to 188.1 mg/dL) declined, alongside improvements in other lipids. Hypertension and dyslipidemia awareness and treatment increased, but BP control peaked at 32.5% in 2013-2014 before declining to 21.5%, while LDL cholesterol control rose from 17.0% to 34.2%. Diabetes awareness increased, but treatment trends were nonsignificant. Glycemic control peaked at 51.2% in 2003-2004 before declining to 41.9% (P for nonlinearity <0.001). Predicted 10-year total CVD risk declined from 5.66% to 5.28%; atherosclerotic CVD (ASCVD) risk declined by 0.16 percentage points per decade (95% CI, 0.22 to 0.09), while heart failure (HF) risk increased by 0.10 (95% CI, 0.03-0.17). Their 2021-2023 estimates were nearly identical (3.20% and 3.19%, respectively); 30-year risks showed similar divergence. Conclusions: Improvements in smoking, blood pressure, and lipids coexisted with rising obesity and diabetes, declining blood pressure control after earlier gains, and divergent predicted ASCVD and HF risks.
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Ahmed et al. (2026) conducted a cross-sectional in Cardiovascular risk factors and predicted cardiovascular disease risk (n=60,199). Temporal trend across NHANES survey cycles (2021-2023 vs 1999-2000; modeled per decade) vs. 1999-2000 baseline NHANES survey cycle was evaluated on Age-standardized obesity prevalence (BMI ≥30 kg/m² or elevated waist circumference) (OR 1.23, 95% CI 1.16-1.30). Among US adults from 1999 to 2023, obesity and diabetes increased while smoking declined, with diverging ASCVD and heart failure predicted risks.
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