National trends in screening, prevalence, and treatment of cardiovascular risk factors

Few studies have documented national trends in screening, awareness, and treatment of cardiovascular risk factors. We evaluated trends in screening, prevalence, and treatment of hypertension, hypercholesterolemia, and smoking.

Data were analyzed from the 1984-1998 Behavioral Risk Factor Surveillance System, a series of yearly cross-sectional population-based surveys of U.S. adults. Unadjusted and adjusted time trends (age-, gender-, ethnicity-, education-, and income-adjusted) in screening, prevalence, and treatment were evaluated.

From 1984 to 1998, a larger proportion of U.S. adults were older, more educated, richer, and Hispanic. Hypertension screening was >97% (1988-1998), prevalence ranged from 21 to 24% (1984-1998), and approximately 58% (1984-1992) were prescribed blood-pressure-lowering medications. Hypercholesterolemia screening increased from 47 to 67% (1987-1998), prevalence from 18 to 31% (1987-1998), and cholesterol-lowering prescriptions from 22 to 25% (1988-1990). Smoking prevalence remained around 28% (1984-1998), while quit attempts declined from 63 to 47% (1990-1998).

Although screening for hypertension and hypercholesterolemia has increased, a substantial proportion of cases were not being prescribed medications. While the prevalence of smoking remains constant, quit attempts have fallen. Continuing challenges for cardiovascular disease prevention include identification of individuals with hypercholesterolemia, appropriate prescription (initiation and/or maintenance) of antihypertensive and lipid-lowering medications, and intensifying smoking cessation efforts.