美国贝斯以色列女执事医疗中心Rishi K. Wadhera团队研究了2009年至2020年3月，美国20至44岁成年人的心血管危险因素患病率、治疗和控制情况。2023年3月5日出版的《美国医学会杂志》发表了这项成果。

在过去十年中，美国心血管死亡率的下降停滞不前，部分原因是老年人风险因素控制恶化。目前尚不清楚20至44岁的青年人中心血管危险因素的患病率、治疗和控制发生了怎样的变化。

为了确定2009年至2020年3月，20岁至44岁的成年人中心血管危险因素（高血压、糖尿病、高血脂、肥胖和吸烟）的患病率、治疗率和控制是否发生了总体变化，以及性别、种族和民族的变化，研究组对参加国家健康和营养调查（2009-2010年至2017年–2020年3月）的美国20至44岁成年人进行了系列横断面分析。主要结局为高血压、糖尿病、高血脂、肥胖症和吸烟史患病率的全国趋势；高血压和糖尿病的治疗率；以及接受治疗者的血压和血糖控制。

在12924名20至44岁的美国成年人（平均年龄31.8岁；50.6%为女性）中，2009-2010年高血压患病率为9.3%，2017-2020年为11.5%。2009-2010年至2017-2020年，糖尿病（从3.0%上升至4.1%）和肥胖症（从32.7%上升至40.9%）患病率有所增加，而高脂血症患病率则有所下降（从40.5%下降至36.1%）。

在整个研究期间，黑人成年人（2009-2010年：16.2%；2017-2020年：20.1%），墨西哥裔美国成年人（从6.5%上升至9.5%）和其他西班牙裔成年人（从4.4%上升到10.5%）的高血压发病率很高，且墨西哥裔美国人的糖尿病发病率显著上升（从4.3%上升到7.5%）。接受高血压治疗的青年人实现血压控制的比例没有显著变化（从2009-2010年的65.0%到2017-2020年的74.8%），而接受糖尿病治疗的年轻成年人的血糖控制在整个研究期间仍不理想（2009-2010年：45.5%；2017-2020年：56.6%）。

研究结果表明，在美国，从2009年到2020年3月，年轻人的糖尿病和肥胖症有所增加，而高血压没有改变，高脂血症有所下降。不同种族和族裔的趋势有所不同。

附：英文原文

Title: Cardiovascular Risk Factor Prevalence, Treatment, and Control in US Adults Aged 20 to 44 Years, 2009 to March 2020

Author: Rahul Aggarwal, Robert W. Yeh, Karen E. Joynt Maddox, Rishi K. Wadhera

Issue&Volume: 2023-03-05

Abstract:

Importance  Declines in cardiovascular mortality have stagnated in the US over the past decade, in part related to worsening risk factor control in older adults. Little is known about how the prevalence, treatment, and control of cardiovascular risk factors have changed among young adults aged 20 to 44 years.

Objective  To determine if the prevalence of cardiovascular risk factors (hypertension, diabetes, hyperlipidemia, obesity, and tobacco use), treatment rates, and control changed among adults aged 20 to 44 years from 2009 through March 2020, overall and by sex and race and ethnicity.

Design, Setting, and Participants  Serial cross-sectional analysis of adults aged 20 to 44 years in the US participating in the National Health and Nutrition Examination Survey (2009-2010 to 2017–March 2020).

Main Outcomes and Measures  National trends in the prevalence of hypertension, diabetes, hyperlipidemia, obesity, and smoking history; treatment rates for hypertension and diabetes; and blood pressure and glycemic control in those receiving treatment.

Results  Among 12924 US adults aged 20 to 44 years (mean age, 31.8 years; 50.6% women), the prevalence of hypertension was 9.3% (95% CI, 8.1%-10.5%) in 2009-2010 and 11.5% (95% CI, 9.6%-13.4%) in 2017-2020. The prevalence of diabetes (from 3.0% [95% CI, 2.2%-3.7%] to 4.1% [95% CI, 3.5%-4.7%]) and obesity (from 32.7% [95% CI, 30.1%-35.3%] to 40.9% [95% CI, 37.5%-44.3%]) increased from 2009-2010 to 2017-2020, while the prevalence of hyperlipidemia decreased (from 40.5% [95% CI, 38.6%-42.3%] to 36.1% [95% CI, 33.5%-38.7%]). Black adults had high rates of hypertension across the study period (2009-2010: 16.2% [95% CI, 14.0%-18.4%]; 2017-2020: 20.1% [95% CI, 16.8%-23.3%]), and significant increases in hypertension were observed among Mexican American adults (from 6.5% [95% CI, 5.0%-8.0%] to 9.5% [95% CI, 7.3%-11.7%]) and other Hispanic adults (from 4.4% [95% CI, 2.1%-6.8%] to 10.5% [95% CI, 6.8%-14.3%]), while Mexican American adults had a significant rise in diabetes (from 4.3% [95% CI, 2.3%-6.2%] to 7.5% [95% CI, 5.4%-9.6%]). The percentage of young adults treated for hypertension who achieved blood pressure control did not significantly change (from 65.0% [95% CI, 55.8%-74.2%] in 2009-2010 to 74.8% [95% CI, 67.5%-82.1%] in 2017-2020], while glycemic control among young adults receiving treatment for diabetes remained suboptimal throughout the study period (2009-2010: 45.5% [95% CI, 27.7%-63.3%]) to 2017-2020: 56.6% [95% CI, 39.2%-73.9%]).

Conclusions and Relevance  In the US, diabetes and obesity increased among young adults from 2009 to March 2020, while hypertension did not change and hyperlipidemia declined. There was variation in trends by race and ethnicity.

DOI: 10.1001/jama.2023.2307

Source: https://jamanetwork.com/journals/jama/fullarticle/2802263