Trends in cardiovascular risk factors control among US adults by glycemic statuses, 2007-2018

Understanding the national trends in cardiovascular risk factors control of individuals with prediabetes and diabetes is critical for diabetes prevention and management. Our study aims to estimate how cardiovascular risk factors changed in US adults with different glycemic statuses between 2007-2008 and 2017-2018.

This was a serial cross-sectional study based on the National Health and Nutrition Examination Surveys (between 2007-2008 and 2017-2018 cycle). Non-pregnant American participants aged 20 years or older were included. Cardiovascular risk factors including weight, blood pressure, plasma cholesterol, and smoking by glycemic statuses were estimated. A total of 33 040 American adults were included. From 2007-2008 to 2017-2018, the age-adjusted proportions of individuals who reached weight control (body mass index <30 kg/m2) of both normoglycemia group and prediabetes group had a significant decrease over the study period, while the trend in participants with diabetes was not significant (mean difference: -5.34%, 95% confidence interval: -15.28%, 4.59%; P for trend = 0.298). The age-adjusted means of total cholesterol of all three groups decreased during the study decade (P for trend < 0.010), with participants with diabetes maintaining the lowest level. Individuals with high total cholesterol were more likely to receive statin therapy in the diabetes group. Notably, prediabetes participants had the highest level of total cholesterol and low-density lipoprotein cholesterol and were less likely to achieve lipid control with statin therapy. Sensitivity analysis with the second definition of prediabetes and diabetes resulted in a consistent trend.

In this nationally representative cross-sectional study, we systematically estimated the cardiovascular risk factors control in American adults and found poor weight control in the normoglycemia and prediabetes group. Despite the significant decrease trend of plasma total cholesterol in all groups, the high cholesterol level in the prediabetes group deserves special concern.