High burden of CV risk factors in young adults, a ‘smoldering’ crisis

New data show a high and increasing burden of most cardiovascular (CV) risk factors in young adults aged 20-44 in the United States.

In this age group, over the past 10 years, there has been an increase in the prevalence of diabetes and obesity, no improvement in the prevalence of hypertension, and a decrease in the prevalence of hyperlipidemia. .

Dr Rishi Wadhera

Still, rates of medical treatment for CV risk factors are “surprisingly” low among young adults, said study researcher Rishi Wadhera, MD, of Beth Israel Deaconess Medical Center and Harvard Medical School in Boston. . lecoeur.org | Medscape Cardiology.

The results are “extremely concerning. We are witnessing a simmering public health crisis. The appearance of these risk factors earlier in life is associated with a higher risk of lifelong and life-threatening heart disease,” added Wadhera.

The study was presented March 5 at the American College of Cardiology (ACC) Scientific Session/World Congress of Cardiology (WCC) 2023 and was published simultaneously In JAMA.

The burden of CV risk factors in young adults is “unacceptably high and increasing”, write the co-authors of a JAMA editorial.

“Now is the time for aggressive preventative action in young adults. Without immediate action, there will continue to be an increase in heart disease and the burden it places on patients, families and communities,” say Norrina Allen, PhD, and John Wilkins, MD, with the University of Chicago Feinberg School of Medicine.

Preventing a Tsunami of Heart Disease

The results are from a cross-sectional study of 12,294 U.S. adults ages 20 to 44 (mean age, 32; 51% female) who participated in National Health and Nutrition Survey (NHANES) cycles of 2009-2010 to 2017-March 2020. .

Overall, the prevalence of hypertension was 9.3% in 2009-2010 and increased to 11.5% in 2017-2020. The prevalence of diabetes increased from 3.0% to 4.1% and the prevalence of obesity increased from 32.7% to 40.9%. The prevalence of hyperlipidemia decreased from 40.5% to 36.1%.

Black adults had consistently high rates of hypertension over the study period—16.2% in 2009-2010 and 20.1% in 2017-2020—and significant increases in hypertension occurred in Mexican American adults (from 6.5% to 9.5%) and other Hispanic adults (from 4.4% to 10.5%), while Mexican American adults experienced a significant increase in diabetes (from 4.3% to 7.5%).

Equally concerning, Wadhera said, only about 55% of young adults with hypertension were receiving antihypertensive drugs, and only 1 in 2 young adults with diabetes were receiving treatment. “These low rates were in part due to the fact that many young adults were unaware of their diagnosis,” he noted.

The NHANES data also show that the percentage of young adults who were treated for hypertension and who achieved blood pressure control did not change significantly over the study period (65, 0% in 2009-2010 and 74.8% in 2017-2020). Glycemic control in young adults treated for diabetes remained suboptimal throughout the study period (45.5% in 2009-2010 and 56.6% in 2017-2020).

“The fact that blood pressure control and blood sugar control are so poor is really concerning,” said Jeffrey Berger, MD, director of the Center for the Prevention of Cardiovascular Disease at NYU Langone Heart, who did not participated in the study. lecoeur.org | Medscape Cardiology.

“Even in lipid control, although it’s improved a bit, it’s still only around 30% to 40%. So I think we have a long way to go as a society” , Berger noted.

Double screening

Wadhera said: “We need to redouble our efforts to screen for and treat cardiovascular risk factors like high blood pressure and diabetes in young adults. We need to scale up clinical and public health interventions focused on primordial and primary prevention. in young adults now so that we can avoid a tsunami of long-term cardiovascular disease.

“It’s extremely important for young adults to speak with their health care provider about whether — and when — they should be screened for high blood pressure, diabetes, and high cholesterol,” Wadhera added.

Berger said one problem is that young people often have a “superman or superwoman” outlook and don’t understand they’re at risk for some of these conditions. Studies like this “reinforce the idea that it’s never too young to be verified.”

As a cardiologist who specializes in cardiovascular prevention, Berger said he sometimes hears patients say things like “I never want to need a cardiologist” or “I hope I never need to. a cardiologist”.

“My answer is, ‘There are many types of cardiologists,’ and I think it would be really helpful for a lot of people to see a prevention-focused cardiologist long before they have problems,” he said. -he declares. lecoeur.org | Medscape Cardiology.

“As a system, medicine has become very effective in treating patients with different diseases. I think we need to improve in terms of preventing some of these issues,” Berger added.

In their editorial, Allen and Wilkins state that “the foundations of cardiovascular health begin early in life. These trends of worsening risk factors underscore the importance of focusing on prevention in adolescence and early childhood. adulthood to promote lifelong cardiovascular health.

The study was funded by a grant from the National Heart, Lung, and Blood Institute. Wadhera has consulted for Abbott and CVS Health. Wilkins received personal fees from 3M. Berger disclosed no relevant financial relationship.

American College of Cardiology (ACC)/World Cardiology Congress (WCC) 2023 Scientific Session: Abstract 1044-09.

JAMA. Published online March 5, 2023. Full Text, Editorial

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