Skip to main content

Advertisement

SpringerLink
Log in

Twenty-year trends in cardiovascular risk among men and women in the United States

  • Original Article
  • Published:
Aging Clinical and Experimental Research Aims and scope Submit manuscript

Abstract

Background

Relative to men, women have experienced slower improvement in mortality in the US in recent decades.

Aims

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.

Methods

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.

Results

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.

Conclusions

Recent decreases in cardiovascular risk may lead to future reduction in cardiovascular events and mortality among both women and men.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  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 countries

  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. 2012-1232

  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

  4. Arnett DK, Jacobs DR, Luepker RV et al (2005) Twenty-year trends in serum cholesterol, hypercholesterolemia, and cholesterol medication use The Minnesota Heart Survey, 1980–1982 to 2000–2002. Circulation 112:3884–3891

    Article  Google Scholar 

  5. Crimmins E, Kim JK, Vasunilashorn (2010) Biodemography: new approaches to understanding trends and differences in population health and mortality. Demography 47:S41–S64

    Article  PubMed  PubMed Central  Google Scholar 

  6. Gu Q, Burt VL, Dillon CF et al (2012) Trends in antihypertensive medication use and blood pressure control among United States adults with hypertension the National Health and Nutrition Examination Survey, 2001 to 2010. Circulation 126:2105–2114

    Article  CAS  PubMed  Google Scholar 

  7. Gu Q, Paulose-Ram R, Dillon C et al (2006) Antihypertensive medication use among US adults with hypertension. Circulation 113:213–221

    Article  CAS  PubMed  Google Scholar 

  8. Mann D, Reynolds K, Smith D et al (2008) Trends in statin use and low-density lipoprotein cholesterol levels among US adults: impact of the 2001 National Cholesterol Education Program guidelines. Ann Pharmacother 42:1208–1215

    Article  CAS  PubMed  Google Scholar 

  9. Albert MA, Danielson E, Rifai N et al (2001) Effect of statin therapy on C-reactive protein levels: the pravastatin inflammation/CRP evaluation (PRINCE): a randomized trial and cohort study. JAMA 286:64–70

    Article  CAS  PubMed  Google Scholar 

  10. Kim JK, Alley D, Seeman T et al (2006) Recent changes in cardiovascular risk factors among women and men. J Womens Health 15:734–746

    Article  Google Scholar 

  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 21:789–798

    Article  PubMed  Google Scholar 

  12. Wang Y, Beydoun MA (2007) The obesity epidemic in the United States—gender, age, socioeconomic, racial/ethnic, and geographic characteristics: a systematic review and meta-regression analysis. Epidemiol Rev 29:6–28

    Article  CAS  PubMed  Google Scholar 

  13. Menke A, Casagrande S, Geiss L (2015) Prevalence of and trends in diabetes among adults in the United States, 1988–2012. JAMA 314:1021–1029

    Article  CAS  PubMed  Google 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 

  15. Godsland IF (2001) Effects of postmenopausal hormone replacement therapy on lipid, lipoprotein, and apolipoprotein (a) concentrations: analysis of studies published from 1974 to 2000. Fertil Steril 75:898

    Article  CAS  PubMed  Google Scholar 

  16. Kuh D, Langenberg C, Hardy R et al (2005) Cardiovascular risk at age 53 years in relation to the menopause transition and use of hormone replacement therapy: a prospective British birth cohort study. BJOG 112:476–485

    Article  CAS  PubMed  Google Scholar 

  17. Langer RD, Pradhan AD, Lewis CE et al (2005) Baseline associations between postmenopausal hormone therapy and inflammatory, haemostatic, and lipid biomarkers of coronary heart disease The Women’s Health Initiative Observational Study. Thromb Haemost 93:1108–1116

    Article  CAS  PubMed  Google Scholar 

  18. Pradhan A, Manson J, Rossouw J et al (2002) Inflammatory biomarkers, hormone replacement therapy, and incident coronary heart disease prospective analysis from the Women’s Health Initiative Observational Study. JAMA 288:980–987

    Article  CAS  PubMed  Google Scholar 

  19. Scuteri A, Ferrucci L (2003) Blood pressure, arterial function, structure, and aging: the role of hormonal replacement therapy in postmenopausal women. J Clin Hypertens 5:219–225

    Article  CAS  Google Scholar 

  20. Hersh AL, Stefanickv ML, Stafford RS (2004) National use of postmenopausal hormone therapy: annual trends and response to recent evidence. JAMA 291:47–53

    Article  CAS  PubMed  Google Scholar 

  21. Kanjilal S, Gregg EW, Cheng YJ et al (2006) Socioeconomic status and trends in disparities in 4 major risk factors for cardiovascular disease among US adults, 1971–2002. Arch Intern Med 166:2348–2355

    Article  PubMed  Google Scholar 

  22. Lobo R, Pickar J, Stevenson J et al (2016) Back to the future: hormone replacement therapy as part of a prevention strategy for women at the onset of menopause. Atherosclerosis 254:282–290

    Article  CAS  PubMed  Google Scholar 

  23. Khaw KT, Wareham N (2006) Glycated hemoglobin as a marker of cardiovascular risk. Curr Opin Lipidol 17:637–643

    Article  CAS  PubMed  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 106:3143–3421

    Article  Google Scholar 

  25. Osmond JM, Mintz JD, Dalton B et al (2009) Obesity increases blood pressure, cerebral vascular remodeling, and severity of stroke in the Zucker rat. Hypertension 53:381–386

    Article  CAS  PubMed  Google Scholar 

  26. Ozbey N, Sencer E, Molvalilar S et al (2002) Body fat distribution and cardiovascular disease risk factors in pre-and postmenopausal obese women with similar BMI. Endocr J 49:503–509

    Article  PubMed  Google Scholar 

  27. Zemel PC, Sowers JR (1990) Relation between lipids and atherosclerosis: epidemiologic evidence and clinical implications. Am J Cardio 66:7–12

    Article  Google Scholar 

  28. Seeman TE, Singer BH, Rowe JW et al (1997) Price of adaptation—allostatic load and its health consequences. Arch Intern Med 157:2259–2268

    Article  CAS  PubMed  Google Scholar 

  29. Seeman TE, Crimmins EM, Huang M et al (2004) Cumulative biological risk and socio-economic differences in mortality: MacArthur studies of successful aging. Soc Sci Med 58:1985–1997

    Article  PubMed  Google Scholar 

  30. Aktas MK, Ozduran V, Pothier CE et al (2004) Global risk scores and exercise testing for predicting all-cause mortality in a preventive medicine program. JAMA 292:1462

    Article  CAS  PubMed  Google Scholar 

  31. Reckelhoff J (2001) Gender differences in the regulation of blood pressure. Hypertension 37:1199–1208

    Article  CAS  PubMed  Google Scholar 

  32. Stevenson J, Crook D, Godsland I (1993) Influence of age and menopause on serum lipids and lipoproteins in healthy women. Atherosclerosis 98:83–90

    Article  CAS  Google Scholar 

  33. Colilla S, Crow A, Petkun W et al (2013) Estimates of current and future incidence and prevalence of atrial fibrillation in the US adult population. Am J Cardiol 112:1142–1147

    Article  PubMed  Google Scholar 

  34. Schnabel RB, Yin X, Gona P et al (2015) 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham heart study: a cohort study. Lancet 386:154–162

    Article  PubMed  PubMed Central  Google 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, Hyattsville

    Google Scholar 

  36. Pencina MJ, Navar-Boggan AM, D’Agostino Sr RB et al (2014) Application of new cholesterol guidelines to a population-based sample. N Engl J Med 370:1422–1431

    Article  CAS  PubMed  Google Scholar 

  37. Ridker PM, Cook NR (2013) Statins: new American guidelines for prevention of cardiovascular disease. Lancet 382:1762–1765

    Article  PubMed  Google Scholar 

  38. Whelton P, Carey RM, Aronow WS et al (2017) ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. Hypertension. https://doi.org/10.1161/HYP.0000000000000065

    Article  PubMed  PubMed Central  Google Scholar 

  39. Mehta N, Chang V (2009) Mortality attributable to obesity among middle-aged adults in the United States. Demography 46:851–872

    Article  PubMed  PubMed Central  Google Scholar 

  40. Stewart ST, Cutler DM, Rosen AB (2016) Forecasting the effects of obesity and smoking on US life expectancy. New Engl J Med 361:2252–2260

    Article  Google 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, Hyattsville

    Google Scholar 

  42. Acciai F, Firebaugh G (2017) Why did life expectancy decline in the United States in 2015? A gender-specific analysis. Soc Sci Med 190:174–180

    Article  PubMed  PubMed Central  Google Scholar 

  43. Cacciatore F, Testa G, Langellotto A et al (2012) Role of ventricular rate response on dementia in cognitively impaired elderly subjects with atrial fibrillation: a 10-year study. Dement Geriatr Cogn Disord 34:143–148

    Article  PubMed  Google Scholar 

  44. De la Torre JC (2012) Cardiovascular risk factors promote brain hypoperfusion leading to cognitive decline and dementia. Cardiovasc Psychiatry Neurol 2012:367516. https://doi.org/10.1155/2012/367516

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Langa KM, Larson EB, Crimmins EM et al (2017) A comparison of the prevalence of dementia in the United States in 2000 and 2012. JAMA Intern Med 177:51–58

    Article  PubMed  PubMed Central  Google Scholar 

  46. Kontis V, Bennett J, Mathers C et al (2017) Future life expectancy in 35 industralised countries: projections with Bayesian model ensemble. Lancet 389:1323–1335

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This research was supported by Grants R24 AG045061 and P30 AG017265 from the National Institute on Aging (NIA).

Author information

Authors and Affiliations

  1. Andrus Gerontology Center, University of Southern California, Los Angeles, CA, 90089-0191, USA

    Jung Ki Kim, Jennifer A. Ailshire & Eileen M. Crimmins

Authors
  1. Jung Ki Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jennifer A. Ailshire
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eileen M. Crimmins
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jung Ki Kim.

Ethics declarations

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.

Informed consent

This study is based on existing public data. Informed consent was obtained by the original collector of the data.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 54 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, J.K., Ailshire, J.A. & Crimmins, E.M. Twenty-year trends in cardiovascular risk among men and women in the United States. Aging Clin Exp Res 31, 135–143 (2019). https://doi.org/10.1007/s40520-018-0932-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40520-018-0932-y

Keywords

Search

Navigation