Million Hearts: Prevalence of Leading Cardiovascular Disease Risk Factors — United States, 2005–2012

Abbreviations: ABCS = aspirin use for secondary prevention, blood pressure control, cholesterol management, smoking assessment and treatment; CI = confidence interval.
*Weighted, unadjusted estimates.
^†t-test for statistically significant differences among demographic subgroups, adjusted for sex, age group, and race/ethnicity, using linear/logistic regression.
^§Source: National Ambulatory Medical Care Survey (NAMCS). Includes office visits to primary care physicians and cardiologists by patients aged ≥18 years with ischemic vascular disease in which aspirin or other antiplatelet medications are prescribed. Excludes visits by patients with a contraindicated condition or medication and obstetric and gynecologic visits.
^¶Source: National Health and Nutrition Examination Survey (NHANES). Blood pressure (BP) control is defined as an average systolic BP <140 mmHg and an average diastolic BP <90 mmHg. Calculated among adults aged ≥18 years with hypertension. Hypertension defined as an average systolic BP ≥140 mmHg, or an average diastolic BP ≥90 mmHg, or self-reported current use of BP-lowering medication, defined as an answer of "yes" to the following questions: "Because of your high blood pressure/hypertension, have you ever been told to take prescribed medicine?" and "Are you currently taking medication to lower your blood pressure?" Excludes pregnant women.
**Source: NHANES. Cholesterol control is defined as a fasting low-density lipoprotein cholesterol (LDL-C) value among adults aged ≥20 years below the target levels (<100 mg/dL for the high risk group, <130 mg/dL for the intermediate risk group, and <160 mg/dL for the low risk group). Calculated among those with LDL-C dyslipidemia, defined using National Cholesterol Education Program's Adult Treatment Panel III risk categories based on the risk for developing coronary heart disease in the next 10 years. Additional information available at http://www.nhlbi.nih.gov/guidelines/cholesterol/index.htm. Current use of cholesterol-lowering medication is defined as an answer of "yes" to the following questions: "To lower your blood cholesterol have you ever been told by a doctor or other health professional to take prescribed medicine?" and "Are you now following this advice to take prescribed medicine?" Excludes pregnant women.
^††Source: NAMCS. Includes physician office visits by persons aged ≥18 years who screened positive for current tobacco use during which tobacco cessation counseling or cessation medications were provided. Additional stratification provided for adults aged 18–24 and 25–44 years because of higher prevalence of tobacco use among these age groups.

Abbreviation: CI = confidence interval.
*Weighted, unadjusted estimates.
^†t-test for statistically significant differences among demographic subgroups, adjusted for sex, age group, and race/ethnicity, using linear/logistic regression.
^§Source: National Survey on Drug Use and Health. Includes current use of combustible tobacco products (i.e., cigarettes, cigars, or pipes) among adults aged ≥18 years. Current cigarette smoking defined as an answer of "yes" to the question, "Have you smoked at least 100 cigarettes in your entire life?" and an answer of "Within the past 30 days" to the question "How long has it been since you last smoked part or all of a cigarette?" Current cigar smoking is defined as an answer of "Within the past 30 days" to the question, "How long has it been since you last smoked part or all of any type of cigar?" Current pipe smoking is defined as an answer of "yes" to the question, "During the past 30 days, have you smoked tobacco in a pipe, even once?"
^¶Sources: National Health and Nutrition Examination Survey and What We Eat in America, U.S. Department of Agriculture. Includes adults aged ≥18 years. The data are estimated from Day 1 dietary recall interviews. The data processing step of adjusting sodium content for salt added during food preparation was discontinued in 2009–2010; equivalent unadjusted estimates for the 2005–2006 and 2007–2008 cycles are based on the default sodium values in the U.S. Department of Agriculture's Food and Nutrient Databases for Dietary Studies 3.0 and 4.1.

Authors and Disclosures

Matthew D. Ritchey, DPT,¹ Hilary K. Wall, MPH,¹ Cathleen Gillespie, MS,¹ Mary G. George, MD¹ and Ahmed Jamal, MBBS,²

¹Division for Heart Disease and Stroke Prevention;
²Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC (Corresponding author: Matthew Ritchey, mritchey@cdc.gov, 770-488-7232)

What Is Already Known on This Topic?

Approximately 1.5 million U.S. adults have a heart attack or stroke each year. These events often lead to long-term disability or death. In 2011, the U.S. Department of Health and Human Services, in collaboration with other key partners, launched Million Hearts, an initiative focused on implementing clinical and community evidence-based strategies to prevent 1 million heart attacks and strokes for the 5-year period 2012–2016.

What Is Added by This Report?

From 2005–2006 to the period with the most current data, prevalence of the Million Hearts "ABCS" of clinical care showed no significant change for aspirin use for secondary prevention (53.8% in 2009–2010), improved to 51.9% for blood pressure control and to 42.8% for cholesterol management (in 2011–2012), and showed no significant change for smoking assessment and treatment (22.2% in 2009–2010). Analysis of two community-level indicators found a decrease in current tobacco product (cigarettes, cigars, or a pipe) smoking prevalence to 25.1% (in 2011–2012) and minimal change in mean daily sodium intake (3,594 mg/day in 2009–2010).

What Are the Implications for Public Health Practice?

Although trends in some measures are encouraging, additional efforts to reduce cardiovascular risk factors are needed to meet the 2017 Million Hearts goals.