Cardiovascular Health Behavior and Health Factor Changes (1988–2008) and Projections to 2020: Results From the National Health and Nutrition Examination Surveys

Study Questions:

Will the American Heart Association (AHA) strategic goals for improvements in overall cardiovascular health be met based on current trends in health behaviors?


Data from the National Health and Nutrition Examination Survey (NHANES) 1988–1994 and subsequent 2-year cycles during 1999–2008 were used for this analysis. Adults (≥20 years) without a diagnosis of cardiovascular disease (CVD) at baseline were included. Metrics for health included smoking, a diet score, physical activity, body weight, glucose levels, and presence of diabetes mellitus (DM), cholesterol levels, and blood pressure. Population prevalence of poor, intermediate, and ideal health behaviors and factors were computed. A composite, individual-level Cardiovascular Health Score, which included all seven metrics, was calculated (poor_0 points; intermediate_1 point; ideal_2 points; total range, 0–14 points). Projected trends for 2020 were based on the assumption that current trends would continue at a similar rate.


A total of 35,059 men and women were included in this study (mean age 44.4 years, 51% women). Prevalence of current and former smoking, hypercholesterolemia, and hypertension declined over time. However, the prevalence of obesity and dysglycemia increased through 2008. Physical activity levels and low diet quality scores demonstrated minimal change over time. Based on these trends, projections to 2020 suggested that obesity and impaired glucose (and DM) would increase, affecting 43% (obesity) and 77% (impaired glucose and DM) of US men and 42% and 53% of US women, respectively. Overall, population-level cardiovascular health is projected to improve by 6% by 2020 if current trends continue. Individual-level Cardiovascular Health Score projections to 2020 (men = 7.4 [95% confidence interval, 5.7–9.1]; women = 8.8 [95% confidence interval, 7.6–9.9]) fall well below the level needed to achieve a 20% improvement (men = -9.4; women = 10.1).


The authors concluded that the AHA’s 2020 target for improving cardiovascular health by 20% will not be reached if current trends continue.


These data suggest that gains seen in reductions in smoking, along with improvements in cholesterol and blood pressure management, may be overshadowed by increases in obesity and concomitant diabetes. The minimal changes in lifestyle factors such as physical activity and diet are likely associated with concerning trends in obesity in the United States. These data highlight the need for aggressive public health interventions to reduce and prevent obesity.

Clinical Topics: Dyslipidemia, Prevention, Homozygous Familial Hypercholesterolemia, Lipid Metabolism, Nonstatins, Hypertension

Keywords: Cholesterol, Cardiovascular Diseases, Obesity, Hypercholesterolemia, Health Status, Hypertension, Health Behavior, Diabetes Mellitus

< Back to Listings