Abstract
Introduction: Cardiovascular disease (CVD) death rates have plateaued. Hence, strategic targets to achieve reduction in CVD death rates set by the American Heart Association (20% by 2020) and others are at risk. Public health initiatives are urgently needed to refocus prevention of CVD in terms of cardiovascular health (CVH) and reduce disparities in CVH. Therefore, we sought to describe US CVH trends from 1999-2014 and forecast to 2050. Methods: We included a representative sample of 39,835 cardiovascular disease-free, non-institutionalized US adults aged ≥20 years. We calculated population prevalence of ideal, intermediate, and poor health behaviors (smoking, diet, physical activity, and body mass index) and health factors (glucose, cholesterol, and blood pressure) and individual-level composite CVH score including all 7 metrics (0-14 points) by sex, race/ethnicity, and education level as a proxy for socioeconomic status. We created forecasts to 2030 and 2050 assuming that observed trends might continue in a linear fashion. Results: Improvements from 1999-2014 in population levels of ideal blood pressure (29 to 38%) and cholesterol (43 to 50%) have been offset by declines in prevalence of ideal body weight (33 to 25%) and glucose (61 to 48%) in men with similar patterns in women and across race and education. Mean CVH score is projected to decline in all adults (men [7.5→6.9], women [7.5→6.8], blacks [7.1→6.0], whites [7.6→6.8], high school education or less [7.1→6.3], and some college education or more [7.9→6.8]) from 2013-2014 to 2050.The figure shows population prevalence by education level of poor, intermediate, and ideal levels of CVH metrics in 2013-2014 and projected prevalence for 2030 and 2050. Discussion: Encouraging progress in cholesterol and blood pressure in recent decades has been negated by persistent disparities and declines in composite CVH. The sobering predictions for 2030 and beyond highlight an urgent need for more effective prevention policies for equitable achievement of ideal CVH.
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