Trends in the prevalence, awareness, treatment, and control of cardiovascular disease risk factors among noninstitutionalized patients with a history of myocardial infarction and stroke

Rates of hypertension, high low density lipoprotein (LDL) cholesterol, and diabetes mellitus awareness, treatment, and control for persons with a history of myocardial infarction and stroke were compared by using two nationally representative samples of the US population: the Third National Health and Nutrition Examination Survey in 1988-1994 (n = 1,004) and the National Health and Nutrition Examination Survey in 1999-2002 (n = 512). Estimated numbers of adult myocardial infarction and stroke survivors increased from 6.32 to 6.78 million and from 3.85 to 4.96 million, respectively. Among such survivors, awareness of a previous diagnosis of hypertension and prevalence of self-reported diabetes mellitus remained stable while awareness of high LDL cholesterol increased from 43.3% to 60.2% (p < 0.01). Among those aware of their diagnosis, pharmacologic treatment for high LDL cholesterol increased from 33.1% to 78.4% and pharmacologic treatment for diabetes mellitus increased from 80.0% to 93.6% during this time (each p < 0.01), while pharmacologic treatment for hypertension increased nonsignificantly. Among those receiving pharmacologic treatment, hypertension and high LDL cholesterol control increased from 48.9% to 59.3% (p = 0.05) and from 5.1% to 33.1% (p < 0.01), respectively. In contrast, glycemic control among diabetics decreased from 45.0% to 33.2% (p = 0.20). The number of US myocardial infarction and stroke survivors increased between 1988-1994 and 1999-2002, and substantial improvements occurred in the awareness, treatment, and control of high LDL cholesterol in this population.