Decline in CHD Prevalence in US Slowing: New Data

January 21, 2022

The prevalence of coronary heart disease (CHD) in the United States has fallen only by a very small and insignificant amount in the past decade, new data show, suggesting that the decline in CHD seen in previous years is now slowing.

"We observed small and insignificant declines in CHD prevalence from 2011 to 2018, which may be influenced by trends in risk factors, including obesity and type 2 diabetes," coauthor of the survey, Cathleen Gillespie, MS, senior statistician at the Centers for Disease Control and Prevention (CDC), told | Medscape Cardiology. "These findings highlight the need for focused CHD preventative and management efforts."

This new information comes from an analysis of data from the Behavioral Risk Factor Surveillance System (BRFSS) from 2011 to 2018, which is reported as a Research Letter published online in JAMA Cardiology on January 19.

The BRFSS is an annual telephone survey conducted by state health departments monthly over landline and cellular telephones with a standardized questionnaire and technical and methodologic assistance from CDC.

The survey is used to collect prevalence data among adults residing in the United States regarding their risk behaviors and preventive health practices that can affect their health status. Each year, a complex design and random-digit dialing are used to obtain representative samples of adults within each state. Since 2011, more than 400,000 interviews have been conducted each year, Gillespie noted.

To assess the prevalence of CHD, participants were asked whether they had ever been told by a medical professional that they have had angina, CHD, or a heart attack.

After the exclusion of participants with missing demographic information, the analytic dataset had information on 3,572,977 adults. Annual prevalence estimates were age-standardized to the 2000 American standard population.

Results showed that from 2011 to 2018, the prevalence of CHD declined slightly, from 6.2% to 6.0% (an absolute change of –0.11%), but this was not statistically significant.

A significant decrease in prevalence was observed for Utah (absolute change, –1.09%), whereas declines in DC (–1.28%); California (–0.72), and Nebraska (–0.70%) approached significance. Significant increases were observed in Oregon and West Virginia.

Small but statistically significant decreases in CHD prevalence were seen in adults 65 years and older (–1.82%) and college graduates (–0.35%), while people 18 to 44 years of age had a small but statistically significant increase (+0.34%).

In 2018, CHD prevalence was greater among men (7.7%) than women (4.6%). Among states, CHD prevalence ranged from 4.0% (DC) to 10.6% (West Virginia).

Gillespie noted that previous results from the BRFSS study showed a decline in CHD prevalence from 6.7% in 2006 to 6.0% in 2010. "So, it appears the declines in CHD prevalence may be slowing," she said.

These data fit with other recent studies that have shown slowing in the decline of CHD death rates at the national level beginning in 2011, she added.

"Although the self-reported data from the BRFSS survey has some acknowledged limitations, the results provide some of the best available estimates of the prevalence of diagnosed CHD among adults throughout the US," Gillespie said.

She suggests that the slowing decline in CHD prevalence may be attributable to corresponding trends in CHD risk factors — the increase in obesity and type 2 diabetes, and high sodium intake and hypertension prevalence — which have plateaued.

"Other factors not examined in our study that could impact risk factors and CHD include Medicaid expansion by states and differences in social determinants of health," she added.

The authors acknowledge that these data have several limitations, including reliance on self-reported information, which increases the possibility of under-reporting, the exclusion of institutionalized settings, which may limit generalizability of the findings, and the addition of cellular phones and change in methodology, which inhibits direct comparisons with earlier results.

Gillespie added that a major challenge for this and other CDC surveys is declining response rates over the years, which can affect the representativeness of the sampled participants. "CDC continues to address this challenge in efforts to improve participation," she commented.

The authors of this study report no disclosures.

JAMA Cardiol. Published online January 19, 2022. Abstract


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