Physicians' Academy for Cardiovascular Education

Increased prevalence of diabetes and obesity among young US adults

Cardiovascular Risk Factor Prevalence, Treatment, and Control in US Adults Aged 20 to 44 Years, 2009 to March 2020

Literature - Aggarwal R, Weh RW, Joynt Maddox KE, et al. - JAMA. 2023 Mar 21;329(11):899-909. doi: 10.1001/jama.2023.2307.

Introduction and methods


The onset of CV risk factors early in life is associated with higher risk of CVD and CV events later in life, and a substantial loss of disability-adjusted life-years and years of life [1-2]. It is therefore important to determine the prevalence of CV risk factors among young adults, as a rise in the burden of CV risk factors could have major public health implications in an aging population.

Aim of the study

The authors investigated if the prevalence of CV risk factors, treatment rates, and control rates changed among young American adults from 2009 to 2020. They investigated this in the overall study population, and stratified by sex, and race and ethnicity.


This was a serial cross-sectional study, using data from the American National Health and Nutrition Examination Survey (NHANES) from 2009 till March 2020. 12,924 adults aged 20 to 44 years old were included. Each NHANES survey was conducted in a 2-year cycle. Because of the COVID-19 pandemic, data from the 2017-2018 and 2019-2020 cycles were combined to ensure nationally representative estimates . Data were collected through in-person interviews and medical examinations. Age, sex, race, and treatment rates were self-reported.


The main outcome was the prevalence of CV risk factors (hypertension, diabetes, hyperlipidemia, obesity, and smoking history).

Main results


Prevalence stratified by race and ethnicity

Treatment and control rates


The prevalence of diabetes and obesity increased (+1.1% and +8.2%, respectively) in American adults aged 20 to 44 years from 2009 to 2020, whereas the prevalence of hypertension did not change and the prevalence of hyperlipidemia decreased (-4.4%). There were significant differences between the prevalence of CV risk factors among people from different racial and ethnic backgrounds. A rising burden of CV risk factors was detected in Hispanic, and Mexican American adults. Moreover, treatment and control rates did not significantly improve over the study period.


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