title: Trends in the prevalence, awareness, treatment, and control of cardiovascular disease risk factors among noninstitutionalized patients with a history of myocardial infarction and stroke.
abstract: Rates of hypertension, high low density lipoprotein (LDL) cholesterol, and diabetes mellitus awareness, treatment, and control for persons with a history of myocardial infarction and stroke were compared by using two nationally representative samples of the US population: the Third National Health and Nutrition Examination Survey in 1988-1994 (n = 1,004) and the National Health and Nutrition Examination Survey in 1999-2002 (n = 512). Estimated numbers of adult myocardial infarction and stroke survivors increased from 6.32 to 6.78 million and from 3.85 to 4.96 million, respectively. Among such survivors, awareness of a previous diagnosis of hypertension and prevalence of self-reported diabetes mellitus remained stable while awareness of high LDL cholesterol increased from 43.3% to 60.2% (p < 0.01). Among those aware of their diagnosis, pharmacologic treatment for high LDL cholesterol increased from 33.1% to 78.4% and pharmacologic treatment for diabetes mellitus increased from 80.0% to 93.6% during this time (each p < 0.01), while pharmacologic treatment for hypertension increased nonsignificantly. Among those receiving pharmacologic treatment, hypertension and high LDL cholesterol control increased from 48.9% to 59.3% (p = 0.05) and from 5.1% to 33.1% (p < 0.01), respectively. In contrast, glycemic control among diabetics decreased from 45.0% to 33.2% (p = 0.20). The number of US myocardial infarction and stroke survivors increased between 1988-1994 and 1999-2002, and substantial improvements occurred in the awareness, treatment, and control of high LDL cholesterol in this population.
authors.affiliation: Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA. pmutner@tulane.edu
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
authors.forename: Karen B
authors.initials: KB
authors.lastname: DeSalvo
authors.forename: Rachel P
authors.initials: RP
authors.lastname: Wildman
authors.forename: Paolo
authors.initials: P
authors.lastname: Raggi
authors.forename: Jiang
authors.initials: J
authors.lastname: He
authors.forename: Paul K
authors.initials: PK
authors.lastname: Whelton
mesh_terms: D000328:Adult; D000368:Aged; D008078:Cholesterol, LDL / Q000097:blood; D003627:Data Interpretation, Statistical; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006937:Hypercholesterolemia / Q000453:epidemiology / Q000517:prevention & control; D006973:Hypertension / Q000453:epidemiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000517:prevention & control*; D009749:Nutrition Surveys; D015995:Prevalence; D012307:Risk Factors; D055502:Secondary Prevention; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control*; D017741:Survivors; D014481:United States / Q000453:epidemiology
chemical_list: D008078:Cholesterol, LDL