Overall, men and women of all age groups in the U.S. failed to meet ideal levels of cardiovascular (CV) health components listed in the American Heart Association’s “Strategic Impact Goals for 2020 and Beyond” initiative, according to an analysis published online Nov. 17 in Circulation. Less than 1 percent of sampled adults met goal levels for all seven components.

The purpose of the study was to provide prevalence estimates of CV health as a baseline for tracking the success of the initiative, which calls for a 20 percent improvement in CV health in the U.S., and a 20 percent reduction in CV diseases and stroke by 2020.

Christina M. Shay, PhD, of the department of preventive medicine at the Feinberg School of Medicine at Northwestern University in Chicago, and colleagues used the 2003 to 2008 National Health and Nutrition Examination Survey (NHANES) to enroll 14,515 adults who were 20 years old or older for the study. Participants were stratified by age (20-39 years as young, 40-60 years as middle and 65 years or more as older), CV health behaviors (diet, physical activity, body mass index [BMI] and tobacco use) and CV health factors (blood pressure, total cholesterol, fasting blood glucose and smoking). Participant’s race/ethnicity also was included for analysis.

CV health metrics included current smoking status, BMI, physical activity level, healthy diet score, total cholesterol, blood pressure and fasting blood glucose. Each participant was assessed in each metric as poor, intermediate or ideal. To achieve ideal CV health, a participant simultaneously had to attain ideal status in all seven CV health components.

“Whereas ideal CV health is just that, ideal, this profile is unlikely to be achieved by large proportions of the U.S. population for the foreseeable future,” Shay and colleagues wrote. “Therefore, clinical and public health programs focused on shifting the entire distribution of CV health toward more favorable levels are needed—particularly among minority populations.”

In general, Shay and colleagues found that ideal CV health prevalence was low in the U.S. population. Key findings include:

• Smoking status was a bright spot. The majority of men and women in all age groups achieved ideal smoking status.
• More than half of the young men and women fell in the intermediate or poor range for BMI, and more than two-thirds of middle age and older adults were overweight or obese.
• Young adults were more likely to engage in ideal levels of physical activity. Non-Hispanic black men reported the highest prevalence of ideal physical activity, while older men and women were more likely to have poor physical activity levels. Women in general had lower ideal physical activity levels than men.
• Less than 1 percent of young men received an ideal healthy diet score. Prevalence of an ideal healthy diet score was highest among the older age group.
• Young adults reached the highest prevalence of ideal levels for total cholesterol, blood pressure and fasting blood glucose. More than two-thirds of young adults had ideal levels of fasting blood glucose.
• Fasting blood glucose was the most prevalent of ideal CV health factors across all groups.

“Since more than 90 percent of U.S. adults report intermediate or poor healthy diet scores, more than two-thirds exhibit intermediate or poor BMI and less than half report physical activity at goal levels, it is likely these unfavorable CV behaviors are substantially responsible for the coinciding unfavorable state of CV health factors in the U.S. adult population,” the authors wrote. “More importantly, improvements in even a single health behavior, such as improvements achieved through weight loss, can result in improvements in multiple CV health factors.”

Shay and colleagues advocated targeting populations identified as intermediate or poor, particularly young adults, with public health programs, lifestyle modifications and, when indicated, drug treatments to reduce their exposure to CV risks.

They noted that some measures in NHANES are self-reported and therefore may be misclassified. To capture a representative sample, they gathered data over a six-year period in which prevalence rates may have changed over time.

They concluded that the seven CV health components are modifiable through lifestyle changes or treatment, offering an opportunity to make improvements in line with the initiative’s goals.