Racial and ethnic differences in controlling risk factors for cardiovascular disease among adults with obesity,...

The burden of obesity may be compounded by disparities in the quality of cardiovascular care across racial and ethnic groups. We aimed to examine racial and ethnic differences in the control of risk factors for cardiovascular disease (CVD) among adults with obesity.

We included nonpregnant US adults with obesity aged ≥20 years who participated in the National Health and Nutrition Examination Survey. Participants from a total of 11 survey cycles between 1999-2000 and 2021-2023 were included. Primary outcome was racial and ethnic differences in controlling all risk factors for CVD (including glycemic, blood pressure and lipid control) among participants, where the risk factor targets were glycated hemoglobin <7.0%, systolic and diastolic blood pressure <140/90 mmHg, and non-high-density lipoprotein cholesterol <3.4 mmol/L, respectively. Multivariable logistic regression models were used for analyses.

A total of 21,982 participants with obesity (mean age: 48.4 years, body mass index: 36.0 kg/m², 53.4% females) were included. Across racial and ethnic groups, most participants were young adults aged <65 years, women, and in low education level. All racial and ethnic groups had a significant improvement of all risk factor control temporally (p values for trend <0.01), with the prevalence ranging from 17.1% in 1999-2004 to 31.4% in 2017-2023 for non-Hispanic White (NHW), from 21.7% to 36.1% for non-Hispanic Black (NHB), and from 19.9% to 35.5% for Mexican American (MA). Relative to other groups throughout the survey cycles, NHW had the highest prevalence of glycemic (ranging from 92.1% to 94.2%) and blood pressure (from 77.5% to 83.9%) control, and NHB had the greatest control of lipids (from 32.0% to 54.2%). NHW demonstrated higher medication use than MA in participants whose risk factor targets were not achieved across the survey cycles.

Across racial and ethnic groups, the majority of participants with obesity were young adults, women, and those in low education. While temporal improvement was found in all groups, racial and ethnic differences in the control of CVD risk factors in adults with obesity still remained. Efforts are required to further explore and confirm these results to help reduce the obesity and CVD burden.