Trends in the cardiovascular risk profile of middle-aged adults

Recent interest in the health of middle-aged adults has centered around the increase in obesity and its possible negative effects on health and health care spending as the baby boomers age and become eligible for Medicare. However, not all trends in the health of this population are unfavorable. Studies suggest that the improvements in risk factors for cardiovascular disease have contributed to the overall decline in heart disease death rates and that the risk profile among the obese has also improved.

This paper uses data from the National Health and Nutrition Examination Surveys (NHANES) to examine trends in the cardiovascular risk profiles of the population aged 45-64. We estimate the coronary heart disease risk functions derived from the Framingham Heart Study (D'Agostino et al. 2001) in 2 time periods (1988-94 and 2001-2004). The risk functions take account of levels of blood pressure (systolic and diastolic), total and HDL cholesterol, diabetes (doctor diagnosed or based on fasting glucose) and smoking status to estimate the 10 year risk of myocardial infarction or coronary death. We estimate the risk functions by sex, age group, and race.

Despite increases in diabetes and obesity, the cardiovascular risk profile of middle-aged adults has improved over time. For example, the mean 10-year risk of heart attack or heart disease death decline from 9.1% to 5.7% among persons 55-64 and from 5.3% to 4.0% among persons 45-54. Declines are seen among both men and women and among non-Hispanic blacks and non-Hispanic whites. Implications of these trends are discussed.