Obesity May Be Most Overlooked Component of ASCVD Prevention Among US Adults

Zahra Aryan, MD, MPH

Obesity is among the overlooked basic components of secondary prevention of atherosclerotic cardiovascular disease (ASCVD) among high-risk patients, according to survey analysis.

In new nationally-representative survey data presented at the American College of Cardiology (ACC) 2022 Scientific Sessions in Washington, DC, this weekend, a team of US investigators reported that diet and weight management—a component among the “ABCDs of ASCVD prevention” guide for clinicians—is grossly under-met per desired body mass index (BMI) threshold goals.

Led by Zahra Aryan, MD, MPH, of the Division of Cardiology, Department of Medicine at Rutgers New Jersey Medical School, investigators sought to investigate the gaps in secondary ASCVD prevention among the US adult population. To do so, they used the 6-item “ABCDs” template to define prevention components.

The components are as follows:

• Antiplatelet therapy: Aspirin 81-162 mg daily indefinitely (Class I recommendation)
• Blood pressure: Pharmacotherapy if ASCVD risk >10% (Class I)
• Cholesterol: Managed with moderate-to-high intensity statins (Class I)
• Cigarette/Tobacco cessation: Counseled to quit and avoid secondhand smoke (Class I)
• Diet/Weight management: Goal BMI is 18.5 – 24.9 kg/m2, measured at least annually (Class I)
• Diabetes prevention and treatment: Goal A1C <7% if can be achieved safely (Class IIb)

Aryan and colleagues used sample adult component data from the 2019 National Health Interview Survey (NHIS) to conduct a cross-sectional analysis of nationally-representative health and disability information for 31,886 US adult survey respondents. They defined ASCD as physician-diagnosed coronary heart disease, myocardial infarction, or stroke.

The projected prevalence of US population with ASCVD was estimated with risk factor modification. Self-reported prevalence of ASCVD was 9.5% (95% CI, 9.3 – 9.9), roughly translating to approximately 24.2 million US adults. Approximately two-thirds of such patients were ≥65 years old, 54.3% were male, and 79.9% were White.

Investigators projected hypertension was prevalent among 76.6% (95% CI, 75.2 – 78.2) of adults with ASCVD; hypercholesterolemia was prevalent among 63.1% (95% CI, 61.9 – 65.3) and diabetes was prevalent among 28.6% (95% CI, 27.0 – 30.3).

Regarding the ABCDs template, the following projected estimates of the US adult population were not meeting the goal of secondary ASCVD prevention components in 2019:

• Antiplatelet therapy: 3.6 million (95% CI, 3.2 – 4.0)
• Blood pressure: 1.6 million (95% CI, 1.4 – 1.8)
• Cholesterol: 2.5 million (95% CI, 2.2 – 2.8)
• Cigarette/tobacco cessation: 3.6 million (95% CI, 3.3 – 3.9)
• Diet/weight management: 17.9 million (95% CI, 17.5 – 18.3)
• Diabetes: 3.0 million (95% CI, 2.8 – 3.3)

“Three fourth of adult population with ACSVD were not at desired BMI goal <25,” investigators wrote. “Obesity is a key component of secondary prevention of ASCVDs that is overlooked in the adult US population.”

The study, “ABCDs of Secondary Prevention of Atherosclerotic Cardiovascular Diseases in the United States: Results of National Health Interview Survey (NHIS) 2019,” was presented at ACC 2022.