Physicians' Academy for Cardiovascular Education

Sex differences in trends, treatment and control of CV risk factors in the US from 2001-2016

Sex Differences in the Prevalence of, and Trends in, Cardiovascular Risk Factors, Treatment, and Control in the United States, 2001 to 2016

Literature - Peters SA, Muntner P, Woodward M. - Circulation. 2019;139:1025–1035. DOI:10.1161/CIRCULATIONAHA.118.035550

Introduction and methods

Although it was thought that men suffered more from CVD, women and men actually have similar CVD lifetime risk [1,2]. Several initiatives, like AHA’s Go Red for Women [3], have tried to create more awareness for CVD in women, but it is unknown whether they made an impact on sex differences in CV risk factor levels and treatment and control patterns. In addition, if trends in prevalence, treatment and control rates for hypertension, diabetes and dyslipidemia have been reported, data for different age and racial groups and with or without previous CVD is usually lacking.

Therefore, sex differences in trends in CV risk factors (blood pressure, cholesterol, HbA1c, weight and smoking) and prevalence, treatment and control of hypertension, diabetes and dyslipidemia in the US from 2001 to 2016 were assessed using data from the National Health and Nutrition Examination Survey (NHANES[4]). Overall trends and stratified by age group, race and those with or without CVD history were quantified.

NHANES enrolls noninstitutionalized US citizen in 2 year cycles, who are selected with a multistage probability sampling approach to generate nationally representative estimates. Data from the 8 2-year NHANES cycles between 2001 and 2016 were used, creating 4 4-year periods (2001–2004, 2005–2008, 2009–2012, and 2013–2016) and 35416 participants were included in the present study. Subgroup analyses were performed by age group (20-34, 35-49, 50-64, 65-79 years), history of CVD and race (Hispanic, non-Hispanic white, non-Hispanic black and other). A summary score (0-4) was created based on presence or absence of 4 risk factors: current smoking, hypertension, diabetes, and dyslipidemia.

Main results


Trends from 2001-2004 to 2013-2016 in SBP, smoking, HDL-c and HbA1c were fairly similar in a representative group of US citizens. Reductions in TC were greater in men than women and increase in BMI was higher in women than men. A lower prevalence of controlled hypertension and diabetes was observed in men and a lower prevalence of controlled dyslipidemia in women. Differences in treatment rates between sexes might explain to some extent the observed differences in control rates.


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