10-Year and 30-Year Risks of Cardiovascular Disease in the U.S. Population

Abstract

Background: The American Heart Association PREVENT (Predicting Risk of Cardiovascular Disease Events) equations were recently developed to estimate risk of total cardiovascular disease (CVD), which includes both atherosclerotic CVD (ASCVD) and heart failure (HF). Long-term risks of total CVD in the U.S. population are unknown. Objectives: This study sought to determine the long-term risks of CVD in the U.S. population. Methods: Using data on U.S. adults aged 30 to 79 years from the National Health and Nutrition Examination Survey between 2011 and 2020, we determined 10- and 30-year risks of total CVD, ASCVD, and HF based on the PREVENT equations. Age-standardized and survey-weighted risk prevalence was determined with further stratification according to age, sex, race, and ethnicity. Results: The study population included 14,184 participants aged 30 to 79 years, representing 160.6 million U.S. adults with and without CVD. The prevalence of existing CVD was 9.6%, including 26.8% among adults aged 65 to 79 years. Survey-weighted prevalence of having elevated (≥7.5%) 10-year predicted risk of developing CVD was 20.2%, although only 10.7% were considered at risk for ASCVD and 12.7% at risk for HF. Prevalence of having elevated 10-year risk of developing CVD was 1.0% in adults aged 30 to 44 years, 18.3% in adults aged 45 to 64 years, and 66.3% in adults aged 65 to 79 years. Due to underlying risk factor profiles, men as well as Black and Hispanic adults had higher 10-year risks of total CVD, ASCVD, and HF. Mean 10-year risks of total CVD, ASCVD, and HF modestly increased over time. For 30-year risks, 66.7% of adults aged 30 to 59 years were without CVD but had elevated total CVD risk, including 89.7% of adults aged 45 to 59 years. Men and Black adults had higher 30-year risks of ASCVD and HF. Conclusions: Three in 10 U.S. adults aged 30 to 79 years have existing CVD or an elevated 10-year predicted risk of CVD, including >90% of adults aged >65 years. Two-thirds of middle-aged adults are without CVD but have an elevated 30-year CVD risk. Men and Black and Hispanic adults are higher risk. These findings emphasize the need for intensive efforts to prevent CVD in the United States.