Krishna K. Patel, MD; Glen B. Taksler, PhD; Bo Hu, PhD; Michael B. Rothberg, MD, MPH
Note: Drs. Patel and Rothberg had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the analysis.
Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health (NIH).
Grant Support: By award T32HL110837 from the National Heart, Lung, and Blood Institute of the NIH (Dr. Patel) and award KL2TR000440 from the National Center for Advancing Translational Sciences (NIH/NCATS) (Dr. Taksler).
Disclosures: Dr. Patel reports grants from the NIH during the conduct of the study. Dr. Taksler reports grants from the NIH/NCATS, administered by the Cleveland Clinical and Translational Science Collaborative, during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-2052.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol: Not available. Statistical code: Available to interested readers working on related analyses by contacting Dr. Patel (e-mail, email@example.com). Data set: Available at www.cdc.gov/nchs/nhanes/nhanes_questionnaires.htm.
Requests for Single Reprints: Krishna K. Patel, MD, Department of Cardiology, Mid America Heart Institute, Saint Luke's Hospital of Kansas City, University of Missouri–Kansas City, 4401 Wornall, 9th Floor/CV Research, Kansas City, MO 64111; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Patel: Department of Cardiology, Mid America Heart Institute, Saint Luke's Hospital of Kansas City, University of Missouri–Kansas City, 4401 Wornall, 9th Floor/CV Research, Kansas City, MO 64111.
Drs. Taksler, Hu, and Rothberg: Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk G-10, Cleveland, OH 44195.
Author Contributions: Conception and design: K.K. Patel, M.B. Rothberg.
Analysis and interpretation of the data: K.K. Patel, G.B. Taksler, B. Hu, M.B. Rothberg.
Drafting of the article: K.K. Patel, G.B. Taksler.
Critical revision for important intellectual content: G.B. Taksler, M.B. Rothberg.
Final approval of the article: K.K. Patel, G.B. Taksler, B. Hu, M.B. Rothberg.
Statistical expertise: G.B. Taksler, B. Hu.
Collection and assembly of data: G.B. Taksler.
The 2013 cholesterol management guidelines from the American College of Cardiology and American Heart Association (ACC/AHA) recommend lipid screening in all adults older than 20 years to identify those at increased risk for atherosclerotic cardiovascular disease (ASCVD). Statins may be considered for patients with elevated 10-year risk (>5%) or a low-density lipoprotein cholesterol (LDL-C) level of 4.92 mmol/L (190 mg/dL) or greater.
To describe the prevalence of elevated ASCVD risk among nondiabetic adults younger than 50 years.
NHANES (National Health and Nutrition Examination Survey), 1999 to 2000 through 2011 to 2012.
Adults aged 30 to 49 years without known ASCVD or diabetes.
10-year ASCVD risk was estimated by using the 2013 ACC/AHA ASCVD risk calculator. Participants were subdivided by age, sex, and history of smoking and hypertension. The percentages of adults in each subgroup with a 10-year ASCVD risk greater than 5% and of those with an LDL-C level of 4.92 mmol/L (190 mg/dL) or greater were estimated. Low-prevalence subgroups were defined as those in which a greater than 1% prevalence of elevated cardiovascular risk could be ruled out (that is, the upper 95% confidence bound for prevalence was ≤1%).
Overall, 9608 NHANES participants representing 67.9 million adults were included, with approximately half (47.12%, representing 32 million adults) in low-prevalence subgroups. In the absence of smoking or hypertension, 0.09% (95% CI, 0.02% to 0.35%) of adult men younger than 40 years and 0.04% (CI, 0.0% to 0.26%) of adult women younger than 50 years had an elevated risk. Among other subgroups, 0% to 75.9% of participants had an increased risk. Overall, 2.9% (CI, 2.3% to 3.5%) had an LDL-C level of 4.92 mmol/L (190 mg/dL) or greater.
No information was available regarding cardiovascular outcomes.
In the absence of risk factors, the prevalence of increased ASCVD risk is low among women younger than 50 and men younger than 40 years.
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Patel KK, Taksler GB, Hu B, Rothberg MB. Prevalence of Elevated Cardiovascular Risks in Young Adults: A Cross-sectional Analysis of National Health and Nutrition Examination Surveys. Ann Intern Med. 2017;166:876–882. doi: 10.7326/M16-2052
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Published: Ann Intern Med. 2017;166(12):876-882.
Published at www.annals.org on 16 May 2017
Cardiology, Coronary Risk Factors, Dyslipidemia, Prevention/Screening.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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