title: Trends in myocardial infarction secondary prevention: The National Health and Nutrition Examination Surveys (NHANES), 1999-2012.
abstract: BACKGROUND
  Nationally representative data evaluating recent trends and future projections of vascular risk factor treatment and control rates in secondary prevention of ischemic heart disease are sparse.
  
  
  RESULTS
  We evaluated sex- and race-stratified cholesterol, blood pressure, and hemoglobin A1c levels and risk factor treatment and control rates in 1580 individuals who self-reported a history of myocardial infarction from The National Health and Nutrition Examination Surveys (NHANES) 1999 to 2012. We used weighted linear regression to estimate time trends and created forward linear projections to 2020. Participants were 30% to 41% women, 73% to 85% white, and had a mean age of 63 to 66 years. Cholesterol treatment rates increased and reached above 80% in men and women by 2011-2012, with significant increases in control rates (as then defined) in men to 85% in 2011-2012, with projections to reach 100% by 2020. Cholesterol treatment rates significantly increased in non-Hispanic whites and Hispanics. Statin use increased significantly to 73% of myocardial infarction survivors by 2011-2012, and aspirin use increased significantly but only to 28% by 2011-2012. There were no changes in blood pressure treatment or control rates by sex, and hypertension treatment increased only in non-Hispanic blacks. Projected hypertension control rates remained suboptimal.
  
  
  CONCLUSIONS
  While temporal trends suggest improvements in cholesterol treatment, unchanged treatment and control of blood pressure and persistently low aspirin use represent missed opportunities. Urgent action is needed to improve secondary prevention rates projected by 2020 to reduce recurrent events in this high-risk group.
authors.affiliation: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (N.S.S., M.D.H., H.N., D.M.L.J.) Department of Medicine, Stanford University School of Medicine, Stanford, CA (N.S.S.).
authors.forename: Nilay S
authors.initials: NS
authors.lastname: Shah
authors.affiliation: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (N.S.S., M.D.H., H.N., D.M.L.J.) Department of Medicine-Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (M.D.H., D.M.L.J.).
authors.forename: Mark D
authors.initials: MD
authors.lastname: Huffman
authors.affiliation: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (N.S.S., M.D.H., H.N., D.M.L.J.).
authors.forename: Hongyan
authors.initials: H
authors.lastname: Ning
authors.affiliation: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (N.S.S., M.D.H., H.N., D.M.L.J.) Department of Medicine-Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (M.D.H., D.M.L.J.).
authors.forename: Donald M
authors.initials: DM
authors.lastname: Lloyd-Jones
mesh_terms: D000368:Aged; D001241:Aspirin / Q000627:therapeutic use; D001786:Blood Glucose / Q000032:analysis; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006937:Hypercholesterolemia / Q000188:drug therapy / Q000517:prevention & control; D006973:Hypertension / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000517:prevention & control*; D009749:Nutrition Surveys / Q000706:statistics & numerical data*; D044469:Racial Groups / Q000706:statistics & numerical data; D055502:Secondary Prevention / Q000706:statistics & numerical data* / Q000639:trends; D012737:Sex Factors; D014481:United States / Q000453:epidemiology
chemical_list: D001786:Blood Glucose; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D001241:Aspirin
keywords: myocardial infarction; secondary prevention; trends