Abstract
Objective
To evaluate the contemporary geographic trends in cardiovascular health in the United
States and its relationship with geographic distribution of cardiovascular mortality.
Methods
By use of a retrospective cross-sectional design, the 2011-2017 Behavioral Risk Factor
Surveillance System (BRFSS) was queried to determine the age-adjusted prevalence of
cardiovascular health index (CVHI) metrics (sum of ideal blood pressure, blood glucose
concentration, lipid levels, body mass index, smoking, physical activity, and diet).
Cardiovascular health was estimated as both continuous (0 to 7 points) and categorical
(ideal, intermediate, poor) variables from the BRFSS. Age-adjusted cardiovascular
mortality for 2017 was obtained from the Centers for Disease Control and Prevention
WONDER database.
Results
Among 1,362,529 American adult participants of the BRFSS 2011-2017 and all American
residents in 2017, the CVHI score increased from 3.89±0.004 in 2011 to 3.96±0.005
in 2017 (Ptrend<.001) nationally, with modest improvement across all regions (Ptrend<.05 for all). Ideal cardiovascular health prevalence improved in the northeastern
(Ptrend=.03) and southern regions (Ptrend=.002). In 2017, the prevalence of coronary heart disease (6.8%; 95% CI, 6.5% to 7.1%)
and stroke (3.7%; 95% CI, 3.4% to 3.9%) was highest in the southern region. The CVHI
score (3.81±0.01) and the prevalence of ideal cardiovascular health (12.2%; 95% CI,
11.7% to 12.7%) were lowest in the southern United States. This corresponded to the
higher cardiovascular mortality in the southern region (233.0 [95% CI, 232.2- to 33.8]
per 100,000 persons).
Conclusion
Despite a modest improvement in CVHI, only 1 in 6 Americans has ideal cardiovascular
health with significant geographic differences. These differences correlate with the
geographic distribution of cardiovascular mortality. An urgent unmet need exists to
mitigate the geographic disparities in cardiovascular morbidity and mortality.
Abbreviations and Acronyms:
BRFSS (Behavioral Risk Factor Surveillance System), CVHI (cardiovascular health index)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 25, 2021
Footnotes
Grant Support: This work is supported by the Minority Health & Health Disparities Research Center, National Institute on Minority Health and Health Disparities (U54MD000502), and the National Institutes of Health Mentored Patient-Oriented Research Award (5K23 HL146887-02) to Dr Pankaj Arora.
Potential Competing Interests: The authors report no competing interests.
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