AUTHOR=Liang Yanting , Liu Fengyao , Yin Han , Shi Xiaohe , Chen Yilin , Wang Haochen , Wang Yu , Bai Bingqing , Liu Yuting , Liu Quanjun , Wu Chao , Yu Xueju , Ma Huan , Geng Qingshan 

TITLE=Trends in unhealthy lifestyle factors in US NHANES respondents with cardiovascular disease for the period between 1999 and 2018

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1169036

DOI=10.3389/fcvm.2023.1169036

ISSN=2297-055X

ABSTRACT=Objectives: To examine national trends in unhealthy lifestyle factors among adults with cardiovascular disease (CVD) in the United States (US) between 1999 and 2018. 
Methods: We analyzed the data from National Health and Nutrition Examination Survey (NHANES), a nationally representative survey of participants aged≥20 years with CVD between 1999-2000 and 2017-2018. CVD was defined as self-report of congestive heart failure, coronary heart disease, angina, heart attack, or stroke. The prevalence of each unhealthy lifestyle factor was calculated among adults with CVD for each of the two-year cycle surveys. Regression analyses were used to assess the impact of sociodemographic characteristics (age, sex, race/ethnicity, family income, education level, marital status, and employment status).
Results: The final sample included 5610 NHANES respondents with CVD. The prevalence of current smoking remained stable among respondents with CVD between 1999-2000 and 2017-2018. During the same period, there was a decreasing trend in the age-adjusted prevalence of poor diet (primary American Heart Association [AHA] score <20; 47.5% [37.9-57.0] to 37.5% [25.7-49.3], p<0.01) Physical inactivity marginally increased before decreasing, with no statistical significance. The prevalence of sedentary behavior increased from 2007 to 2014, but subsequently returned to its original level in 2018, with no statistical significance. The age-adjusted prevalence of obesity increased from 32% (27.2-36.8) in 1999-2000 to 47.9% (39.9-55.8) in 2017-2018 (p<0.001). Age-adjusted prevalence of depression increased from 7% (4.2-9.9) in 1999-2000 to 13.9% (10.2-17.6) in 2017-2018 (p=0.056). Trends in mean for each unhealthy lifestyle factor were similar after adjustment for age. We found respondents who had a low education and income level were at higher risk for unhealthy lifestyle factors (i.e., current smoking, poor diet, and physical inactivity) than those who had a high education and income level.
Conclusions: There is a significant reduction in the prevalence of poor diet among US adults with CVD from 1999 to 2018, while the prevalence of obesity showed increasing trends over this period. The prevalence of current smoking, sedentary behavior, and depression was stable or showed an insignificant increase. These findings suggest that there is an urgent need for health policy interventions targeting unhealthy lifestyles among adults with CVD.