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

  • Changes in SBP over time were similar in woman and men. There were sex differences in SBP trends in those ≥50 years (Pinteraction<0.001), but no differences by CVD status or race. Hypertension prevalence decreased similarly in women and men, and also increase of those with hypertension taking antihypertensive medication and increase in those with controlled BP were similar in both sexes. In 2013-2016, sex differences in prevalence of hypertension were greatest in younger adults and treatment and control rates for hypertension were higher in women than men at younger age. Also, treatment rates in 2013-2016 were higher in those with than those without CVD history in both women and men and no sex differences existed for different race groups.
  • Mean BMI increased from 28.1 (2001-2004) to 29.6 kg/m² (2013-2016) in women and from 27.9 to 29.0 kg/m² in men (Pinteraction=0.006). There were only small differences in trends across age groups and by CVD status.
  • There was no difference in decrease in smoking rates between sexes. Smoking rates were highest in youngest adults for both men and women and there were sex-differences in smoking rates across different race groups (lower smoking rates for women).
  • Decrease in HDL-c levels from 2001-2004 to 2013-2016 was similar for women and men. Reduction in TC was greater in men than women (203 to 194 mg/dL in women and 201 to 188 mg/dL in men, Pinteraction=0.002). In each calendar period, TC was similar for women and men aged <35 years, lower among women than men of 35 to 49 years, and higher in women than men in the 2 older age groups. Men were more likely to be treated and have controlled dyslipidemia, especially at older age, compared to women. In 2013-2016, in those with history of CVD, more men than women had dyslipidemia. There were no sex differences in treatment and control rated by CVD status.
  • Mean HbA1c levels increased similarly for women and men over time. In 2013-2016, prevalence of diabetes was lower for women than men, but prevalence of diabetes increased similarly for both sexes over time. Treatment rate for diabetes increased similarly for women and men over time and control rates were similar or higher in women. In 2013-2016, there was no differences in treatment and control rates by age, CVD status, or race.
  • There was no major variation in distribution of number of risk factors for both women and men over time. In both sexes, percentage with ≥1 risk factors increased with age and was higher for those with CVD history than those without. Non-Hispanic black women and men had the highest number of risk factors.


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.


1 Albrektsen G, Heuch I, Lochen ML, et al. Lifelong gender gap in risk of incident myocardial infarction: the Tromso Study. JAMA Intern Med. 2016;176:1673–1679.

2. Leening MJ, Ferket BS, Steyerberg EW, et al. Sex differences in lifetime risk and first manifestation of cardiovascular disease: prospective population based cohort study. BMJ. 2014;349:g5992.

3. American Heart Association. Go Red For Women website. 2017. Accessed April 3, 2018.

4. National Center for Health Statistics. National Health and Nutrition Examination Survey. Accessed April 5, 2018.

Find this article online at Circulation

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