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![]() Persons using assistive technology might not be able to fully access information in this file. For assistance, please send e-mail to: mmwrq@cdc.gov. Type 508 Accommodation and the title of the report in the subject line of e-mail. Prevalence of Adults With No Known Major Risk Factors for Coronary Heart Disease -- Behavioral Risk Factor Surveillance System, 1992Although the death rate for coronary heart disease (CHD) in the United States has declined approximately 50% since 1970, CHD remains the leading cause of death for both men and women and, in 1990, accounted for 489,340 deaths (1). National strategies and programs have targeted individual risk factors for death attributed to CHD. However, an alternative approach may be to measure the prevalence of adults who have no known risk factors for CHD. This report provides state-specific estimates of and characterizes adults who report having no known major risk factors for CHD. Data were analyzed from 91,428 persons aged greater than or equal to 18 years who resided in 48 states and the District of Columbia and participated in the 1992 Behavioral Risk Factor Surveillance System (BRFSS), a random-digit-dialed telephone survey. The analysis examined survey responses regarding the following risk factors: current cigarette smoking (smoked at least 100 cigarettes in their lifetime and now smoking), physical inactivity (no or irregular leisure-time physical activity), overweight (body mass index greater than or equal to 27.3 for women and greater than or equal to 27.8 for men), high blood pressure (told more than once by a health professional he/she has high blood pressure or is currently taking antihypertensive medications), high blood cholesterol (ever told by a health professional he/she has high blood cholesterol), and diabetes (ever told by a doctor he/she has diabetes). Persons who reported having none of these risk factors were defined as having no known risk factors for CHD. The results were weighted to account for the distribution of demographic characteristics in each state. To determine the actual prevalence of adults in each state with no known CHD risk factors, state-specific estimates were not standardized to a referent population. For data aggregated from all states, census data for the 1980 U.S. population were used to standardize comparisons by age, race, and educational status; aggregated analyses were restricted to black and white respondents for whom the age, race, and education distributions of the population were known. SESUDAAN was used to calculate the standard errors for the prevalence estimates (2). Of the 91,428 respondents, 18% reported having none of the six major CHD risk factors; 35% reported having one risk factor; 29%, two risk factors; 13%, three risk factors; and 5%, four to six risk factors. In every state, less than 30% of the population had no known risk factors. The state-specific proportion of respondents with no known risk factors varied minimally; in 45 (92%) of the states, the proportion ranged from 14% to 26% (Table_1). For both males and females, the percentage of respondents with no known risk factors was highest for 18-34-year-olds. Among males, the percentage was lowest for those aged 50-64 years, and among females, the percentage varied inversely with age (Table_2). The prevalence of no known risk factors for CHD increased directly with increasing level of education. Reported by the following BRFSS coordinators: M Scott, Alabama; P Owen, Alaska; R Porter, Arizona; L Lund, California; M Leff, Colorado; M Adams, Connecticut; F Breukelman, Delaware; C Mitchell, District of Columbia; D McTague, Florida; E Pledger, Georgia; F Newfield, Hawaii; G Louis, Idaho; B Steiner, Illinois; R Guest, Indiana; P Busick, Iowa; K Pippert, Kansas; K Bramblett, Kentucky; D Hargrove-Roberson, Louisiana; D Maines, Maine; A Weinstein, Maryland; R Lederman, Massachusetts; H McGee, Michigan; N Salem, Minnesota; E Jones, Mississippi; J Jackson-Thompson, Missouri; P Smith, Montana; S Huffman, Nebraska; M Atherton, Nevada; K Zaso, New Hampshire; G Boeselager, New Jersey; E Plunkett, New Mexico; C Baker, New York; C Washington, North Carolina; B Burgum-Lee, North Dakota; E Capwell, Ohio; N Hann, Oklahoma; J Grant-Worley, Oregon; C Becker, Pennsylvania; J Buechner, Rhode Island; M Lane, South Carolina; B Miller, South Dakota; D Ridings, Tennessee; R Diamond, Texas; R Giles, Utah; P Brozicevic, Vermont; R Schaeffer, Virginia; T Jennings, Washington; F King, West Virginia; E Cautley, Wisconsin. P Remington, Bur of Public Health, Wisconsin Div of Health. Cardiovascular Health Studies Br, Div of Chronic Disease Control and Community Intervention, National Center for Chronic Disease Prevention and Health Promotion, CDC. Editorial NoteEditorial Note: The finding in this report that, in 1992, only 18% of adults reported having no known risk factors for CHD indicates that, despite improvements in the treatment and control of CHD-related conditions, a substantial percentage of adults continue to be at risk for CHD. This low prevalence underscores the need for primary prevention efforts that focus on achieving behavioral changes that prevent the occurrence of risk factors. Several of the year 2000 national health objectives target the primary prevention of specific risk factors for CHD, including overweight (objective 15.10), physical inactivity (objective 15.11), high blood cholesterol (objective 15.7), and cigarette smoking (objective 15.12) (3). Achievement of these objectives should substantially increase the number of U.S. adults who have no known major risk factors for CHD and should further reduce CHD-associated mortality. The prevalences of two risk factors -- cigarette smoking and high blood cholesterol -- have decreased substantially. In 1965, approximately 40% of U.S. adults smoked cigarettes; in comparison, by 1991, 26% smoked cigarettes (4). In addition, from the second National Health and Nutrition Examination Survey (NHANES II) (1976- 1980) to NHANES III (1988-1991), the proportion of adults with high blood cholesterol levels (greater than or equal to 240 mg/dL) decreased from 26% to 20% (5). For other risk factors, however, prevalences have remained constant or increased. For example, when compared with 1987, the proportion of adults who engaged in no leisure-time physical activity (24%) in 1991 was unchanged, and the proportion who engaged in moderate physical activity five or more times per week increased only slightly (22% in 1987 and 24% in 1991) (6). From 1987 through 1991, the proportion of U.S. adults who were overweight increased from 26% to 28%, respectively (6). Finally, despite substantial improvements in the awareness, treatment, and control of hypertension, hypertension continues to affect an estimated 50 million persons in the United States (7). Although the findings in this report assist in targeting efforts to reduce specific risk factors for CHD, these findings are subject to at least two limitations. First, because BRFSS estimates are based on self-reports, the prevalence of most risk factors, especially overweight and current smoking status, are likely to be underreported. Second, risk factors for which awareness is low are underreported; for example, only an estimated 29% of adults know their cholesterol level (8). Therefore, this report most likely overestimates the proportion of adults without CHD risk factors. To assist in reducing the prevalence of CHD risk factors, health programs and organizations have intensified advocacy of primary prevention strategies. For example, the National High Blood Pressure Education Program has developed policy recommendations for implementing primary prevention interventions for hypertension (9), and the National Cholesterol Education Program has made dietary recommendations to reduce cholesterol levels (10). The need for the primary prevention of CHD risk factors also is important because education or treatment of persons with established risk factors may not reduce their risk to the level of persons who never have the risk factor; for example, persons who effectively control their hypertension remain at higher risk for CHD than do persons who never develop hypertension (9). References
TABLE 1. Percentage of adults who reported having no known major risk factors for coronary heart disease,* by state -- Behavioral Risk Factor Surveillance System, 1992 ================================================================================================== % With % With Sample no risk Sample no risk State size factors (95% CI +) º State size factors (95% CI) ---------------------------------------------------------------------------------------- Alabama 2115 24.5 (+/-2.0) º Montana 1160 22.8 (+/-2.8) Alaska 1463 26.4 (+/-3.6) º Nebraska 1527 21.1 (+/-2.4) Arizona 1737 19.9 (+/-2.7) º Nevada 1561 22.8 (+/-2.5) California 3831 24.8 (+/-1.6) º New Colorado 1753 28.2 (+/-2.4) º Hampshire 1408 23.8 (+/-2.7) Connecticut 1630 21.0 (+/-2.2) º New Jersey 1363 19.6 (+/-2.4) Delaware 1417 19.3 (+/-2.5) º New Mexico 1127 21.6 (+/-2.8) District of º New York 2227 18.1 (+/-1.8) Columbia 1405 19.4 (+/-2.6) º North Carolina 2012 17.5 (+/-1.9) Florida 2613 20.4 (+/-1.7) º North Dakota 1731 19.9 (+/-2.2) Georgia 1903 17.8 (+/-2.1) º Ohio 1232 16.7 (+/-2.3) Hawaii 1853 21.5 (+/-2.3) º Oklahoma 1419 18.7 (+/-2.6) Idaho 1697 25.1 (+/-2.4) º Oregon 3158 26.0 (+/-1.7) Illinois 2095 19.9 (+/-2.0) º Pennsylvania 2309 18.7 (+/-1.8) Indiana 2277 17.2 (+/-1.9) º Rhode Island 1733 24.5 (+/-2.3) Iowa 1601 18.9 (+/-2.2) º South Carolina 1860 14.4 (+/-2.0) Kansas 1338 23.6 (+/-2.6) º South Dakota 1667 9.4 (+/-1.6) Kentucky 2039 15.2 (+/-1.9) º Tennessee 2582 16.9 (+/-1.6) Louisiana 1560 15.9 (+/-2.2) º Texas 2361 21.1 (+/-1.9) Maine 1205 20.7 (+/-2.6) º Utah 1721 28.9 (+/-2.4) Maryland 2038 18.5 (+/-1.9) º Vermont 1819 24.7 (+/-2.3) Massachusetts 1408 26.1 (+/-2.6) º Virginia 1683 24.1 (+/-2.3) Michigan 2344 18.6 (+/-1.8) º Washington 2425 26.9 (+/-2.0) Minnesota 3339 22.4 (+/-1.6) º West Virginia 2318 14.1 (+/-1.6) Mississippi 1450 14.3 (+/-2.2) º Wisconsin 1469 20.6 (+/-2.5) Missouri 1440 18.5 (+/-2.2) º ---------------------------------------------------------------------------------------- * Risk factors: current cigarette smoking (smoked at least 100 cigarettes in their lifetime and now smoking), physical inactivity (no or irregular leisure-time physical activity), overweight (body mass index >=27.3 for women and >=27.8 for men), high blood pressure (told more than once by a health professional he/she has high blood pressure or is currently taking antihyper- tensive medications), high blood cholesterol (ever told by a health professional he/she has high blood cholesterol), and diabetes (ever told by a doctor he/she has diabetes) + Confidence interval. ================================================================================================== Return to top. Table_2 Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size. TABLE 2. Percentage of adults who reported having no known major risk factors for coronary heart disease, * by age group, education level, and sex -- Behavioral Risk Factor Surveillance System, 1992 ================================================================================================== Men Women ------------------------------- ----------------------------- Sample % With no Sample % With no Characteristic size risk factor (95% CI +) size risk factor (95% CI) -------------------------------------------------------------------------------------- Age group (yrs) & 18-34 12,202 24.5 (+/-1.3) 14,647 22.7 (+/-1.1) 35-49 11,652 12.6 (+/-0.9) 13,955 17.9 (+/-1.0) 50-64 6,598 9.4 (+/-1.0) 8,515 11.6 (+/-0.9) >=65 5,601 13.4 (+/-1.2) 10,488 9.2 (+/-0.8) Education (yrs) @ <12 4,961 10.4 (+/-1.5) 7,145 8.5 (+/-1.2) 12 11,577 14.6 (+/-0.9) 16,941 15.9 (+/-0.8) >12 19,515 25.4 (+/-0.9) 23,519 26.9 (+/-0.8) -------------------------------------------------------------------------------------- * Risk factors: current cigarette smoking (smoked at least 100 cigarettes in their lifetime and now smoking), physical inactivity (no or irregular leisure-time physical activity), overweight (body mass index >=27.3 for women and >=27.8 for men), high blood pressure (told more than once by a health professional he/she has high blood pressure or is currently taking antihyper- tensive medications), high blood cholesterol (ever told by a health professional he/she has high blood cholesterol), and diabetes (ever told by a doctor he/she has diabetes). + Confidence interval. & Age comparisons were standardized for education and race by using 1980 U.S. Bureau of the Census data. @ Number of years completed; education comparisons were standardized for age and race by using 1980 U.S. Bureau of the Census data. *. ================================================================================================== Return to top. Disclaimer All MMWR HTML versions of articles are electronic conversions from ASCII text into HTML. This conversion may have resulted in character translation or format errors in the HTML version. Users should not rely on this HTML document, but are referred to the electronic PDF version and/or the original MMWR paper copy for the official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices. **Questions or messages regarding errors in formatting should be addressed to mmwrq@cdc.gov.Page converted: 09/19/98 |
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