Twenty-year trends in cardiovascular risk among men and women in the United States
Relative to men, women have experienced slower improvement in mortality in the US in recent decades.
We investigated 20-year trends in cardiovascular risk for men and women age 40 and over in the US to determine whether there was differential change in risk for men and women.
Using the National Health and Nutrition Examination Survey (NHANES), we estimated total cardiovascular risk, the prevalence of individual risk factors, and potential factors contributing to change in risk.
Men showed steady reductions in cardiovascular risk over the 20 years; women experienced increased risk from 1990 to 2000, but decreased risk from 2000 to 2010. Sex differences in cardiovascular risk changed so that there was no significant difference by sex at any age over 50 in 2010. Large decreases in the prevalence of high risk lipids were important causes of reduction in risks for both sexes; changes in blood pressure were less important, except for women in the 2000–2010 period when they equaled the effect of changing lipids. Increasing medication usage and effectiveness drove improvements in blood pressure and total cholesterol for both sexes. In 2010 there was no difference between men and women in the use of antihypertensives or cholesterol-lowering medications. Metabolic risk, as indexed by obesity and HbA1c, increased over time and went against the trend in the summary measure. Diabetes, smoking, and hormone therapy use did not explain changes in high blood pressure or high total cholesterol for either gender.
Recent decreases in cardiovascular risk may lead to future reduction in cardiovascular events and mortality among both women and men.
KeywordsSex difference Cardiovascular risk NHANES Trends
This research was supported by Grants R24 AG045061 and P30 AG017265 from the National Institute on Aging (NIA).
Compliance with ethical standards
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
Statement of human and animal rights
This article does not contain any results where the authors were in contact with human or animal participants.
This study is based on existing public data. Informed consent was obtained by the original collector of the data.
- 1.Crimmins EM, Preston SH, Cohen B (2011) Explaining divergent levels of longevity in high-income countries. National Research Council, panel on understanding divergent trends in longevity in high-income countriesGoogle Scholar
- 2.National Center for Health Statistics (2012) Health, United States, 2011: with special feature on socioeconomic status and health. National Center for Health Statistics (US), Hyattsville. Report no. 2012-1232Google Scholar
- 3.National Research Council (US) Panel on Understanding Divergent Trends in Longevity in High-Income Countries (2011) Difference between life expectancy in the united states and other high-income countries. In: Crimmins EM, Preston SH, Cohen B (eds) Explaining divergent levels of longevity in high-income countries. National Academies Press (US), Washington, DC. http://www.ncbi.nlm.nih.gov/books/NBK62373. Accessed 4 Oct 2017
- 11.Gu Q, Burt VL, Paulose-Ram R et al (2008) Gender differences in hypertension treatment, drug utilization patterns, and blood pressure control among US adults with hypertension: data from the National Health and Nutrition Examination Survey 1999–2004. Am J Hypertens 21:789–798CrossRefPubMedGoogle Scholar
- 14.US Department of Health and Human Services (2014) The health consequences of smoking: 50 years of progress. A report of the Surgeon General. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta (printed with corrections, January 2014)Google Scholar
- 24.National Cholesterol Education Program (NCEP) (2002) Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III) final report. Circulation 106:3143–3421Google Scholar
- 35.Xu JQ, Murphy SL, Kochanek KD et al (2016) Mortality in the United States, 2015. NCHS data brief, no 267. National Center for Health Statistics, HyattsvilleGoogle Scholar
- 41.Kochanek KD, Murphy SL, Xu JQ et al (2017) Mortality in the United States, 2016. NCHS Data Brief, no 293. National Center for Health Statistics, HyattsvilleGoogle Scholar