CDC: Management of cardiovascular risk factors has stalled in the US

Fewer Americans smoked or were physically inactive in 2015-16 than four years earlier, but there were also fewer on “appropriate” aspirin therapy to prevent cardiovascular events, according to a Vital Signs report released by the CDC.

Overall, the findings suggest much work remains to prevent one million acute cardiovascular events by 2022—the goal of an initiative launched in 2017 by HHS and co-led by the CDC and CMS.

“Million Hearts 2022 has set clinical targets of 80 percent performance on the ‘ABCs’ of CVD prevention: aspirin when appropriate, blood pressure control, cholesterol management, and smoking cessation,” wrote Hillary K. Wall, MPH, with the CDC’s Division for Heart Disease and Stroke Prevention, and colleagues. “At the community level, a 20 percent reduction in the prevalence of combustible tobacco product use and of physical inactivity and a 20 percent reduction in mean daily sodium intake are targeted.”

Million Hearts 2022 is also placing a special emphasis on specific at-risk populations, including adults with previous heart attack or stroke, black individuals with hypertension and people with mental health or substance use disorders who use tobacco.

The published data from 2011 to 2016—collected through three national surveys—may serve as a baseline for the CVD risk factors the initiative is targeting, the authors noted. But the stagnation of several of the factors, along with a nationwide plateauing of CVD mortality, is cause for concern.

Specifically, Wall et al. estimated the following shortcomings in CVD risk factor management:

  • 40.2 million Americans are living with uncontrolled hypertension.
  • Nine million people aren’t taking the recommended doses of aspirin to prevent an initial or recurring cardiovascular event.
  • 39.1 million adults aren’t taking the recommended statin therapy to manage their cholesterol.
  • 54.1 million adults are smokers.
  • 70.7 million adults aren’t physically active.

“If the population deficits for each risk factor in this analysis are summed, they represent approximately 213 million opportunities for better risk factor prevention and management, many of which might be present in the same person,” the authors wrote. “More than half of these opportunities are among adults aged 35–64 years.”

For this reason, Wall et al. said another emphasis of the Million Hearts initiative is targeting risk factor management in younger U.S. adults, who have experienced an increasing CVD burden in recent years.

“It will require a concerted national implementation effort to prevent one million acute cardiovascular events by 2022,” the researchers wrote.