Report: More than 25% of US Adults Has 1 or More Cardiac, Renal, or Metabolic Conditions

John Ostrominski, MD
Credit: Brigham and Women's Hospital

A new analysis examining 2 decades of trends in the prevalence and overlap of cardiac, renal, and metabolic conditions among US adults paints a concerning picture investigators suggest will need addressing with concerted public health efforts.

Results of the analysis, which looked at changes in prevalence from 1999 through 2020, indicate more than 25% of US adults had at least 1 cardiac, renal, or metabolic condition and 1.5% had all 3 by the end of the study period, with results pointing to significant disparities in prevalence based on patient age as well as racial/ethnic background.¹

“This analysis shows [cardiac, renal, and metabolic] multimorbidity is increasingly prevalent and historically undertreated among US adults, supporting the development of team-based, comprehensive, and equitable management strategies to enable attainment of prevention and treatment goals throughout the life span and across the [cardiac, renal, and metabolic] continuum,” investigators wrote.¹

In the last 2 decades, the US public and medical community has witnessed a perfect storm of increasing awareness and advances, placing cardiorenal metabolic health at the forefront of public health efforts. Despite this, the rising rates of obesity, combined with the degradation of lifestyle factors, have contributed to increased rates of other chronic diseases, such as type 2 diabetes, chronic kidney disease, and heart failure. At the same time, revelations surrounding new pharmacologic agents, namely SGLT2 inhibitors, finerenone, and GLP-1 receptor agonists, have driven conversations around the potential for certain classes in the management of multiple cardiac, renal, and metabolic conditions.^2,3

Led by John Ostrominski, MD, of the Brigham and Women’s Hospital Heart and Vascular Center, along with colleagues representing Baylor, Scott, and White Research Institute, Saint Luke’s Mid America Heart Institute, and UCLA, the current suited was launched with the intent of assessing trends in prevalence of individual and overlapping cardiac, renal, and metabolic conditions from 1999 through 2020. To do so, investigators designed their study as a cross-sectional analysis of data obtained from the National Health and Nutrition Examination Survey (NHANES), with a focus on survey cycles occurring from 1999 through 2020.¹

The first portion of the study sought to assess the prevalence of cardiac, renal, and metabolic conditions using data recorded during survey cycles occurring from 2015 through 2020. For the purpose of analysis, the proportion of participants with these conditions was classified as overall and also stratified by and defined as cardiovascular disease, chronic kidney disease, type 2 diabetes, or all 3. The second aim of the study, to assess temporal trends in cardiac, renal, and metabolic condition overlap, was performed through a comparison NHANES data recorded between 1999 and 2002 against data recorded from 2015 and 2020.¹

From survey cycles occurring from 2015 through 2020, a total of 11,607 adults were identified for inclusion in the analysis. This cohort had a mean age of 48.5 years and 51.0% were women. Investigators pointed out 15.3% were Hispanic, 5.4% were non-Hispanic Asian, 10.6% were non-Hispanic Black, and 64.8% were non-Hispanic White, with 3.9% reporting being of another race or ethnicity or multiracial.¹

Among this cohort, 26.3% had at least 1 cardiac, renal, or metabolic condition, 8.0% had at least 2 cardiac, renal, or metabolic conditions, and 1.5% had 3 cardiac, renal, or metabolic conditions. Further analysis revealed chronic kidney disease plus type 2 diabetes was the most prevalent cardiac, renal, or metabolic dyad (3.2%), followed by cardiovascular disease plus type 2 diabetes (1.7%), and cardiovascular disease plus chronic kidney disease (1.6%). Analysis of risk factors revealed elevated age and male sex were associated with greater cardiac, renal, or metabolic comorbidity burden.¹

When limiting their analysis to patients aged 65 years and older, the prevalence of those with at least 1 cardiac, renal, or metabolic condition increased to 33.6% while prevalence of 2 and 3 cardiac, renal, or metabolic conditions increased to 17.1% and 5.0%, respectively.¹

Investigators pointed out a disproportionately high burden of cardiac, renal, or metabolic comorbidity was observed among patients reporting non-Hispanic Black race or ethnicity, unemployment, low socioeconomic status, and no high school degree. Assessments of medications use among a subgroup of those with 3 cardiac, renal, or metabolic conditions indicated 30.5% were not using statin, only 4.8% reported GLP-1 receptor agonist use, and just 3.0% reported SGLT2 inhibitor use. Investigators also called specific attention to the prevalence of key risk factors, with prediabetes, hypercholesterolemia, hypertension, and obesity were present in 25.9%, 29.0%, 38.5%, and 41.2% of the entire study cohort, respectively.¹

When assessing trends in prevalence of cardiac, renal, or metabolic conditions over time, results indication the proportion of US adults with multiple conditions increases significantly from 5.3% in 1999 to 8.0% in 2020 (P <.001). Similarly, the proportion of those having all 3 cardiac, renal, or metabolic conditions increased from 0.7% to 1.5% (P < .001).¹

“These data reinforce the need to embrace the complexities imposed by concurrent [cardiac, renal, and metabolic] conditions in research efforts, clinical practice, guideline development, and the formulation of public health policy,” investigators wrote.¹

References:

1. Ostrominski JW, Arnold SV, Butler J, et al. Prevalence and Overlap of Cardiac, Renal, and Metabolic Conditions in US Adults, 1999-2020. JAMA Cardiol. Published online September 27, 2023. doi:10.1001/jamacardio.2023.3241
2. Campbell P, Iapoce C. 10 years of obesity: A Decade of Advancement and challenges. HCP Live. June 23, 2023. Accessed September 28, 2023. https://www.hcplive.com/view/10-years-of-obesity-a-decade-of-advancement-and-challenges.
3. Campbell P, Iapoce C. 10 years of SGLT2 inhibitors: A Decade of Redefining Cardiometabolic Care. HCP Live. March 29, 2023. Accessed September 28, 2023. https://www.hcplive.com/view/10-years-of-sglt2-inhibitors-a-decade-of-redefining-cardiometabolic-care.