Trends in Myocardial Infarction Secondary Prevention: The National Health and Nutrition Examination Surveys (NHANES), 1999-2012

Background-Nationally representative data evaluating recent trends and future projections of vascular risk factor treatment and control rates in secondary prevention of ischemic heart disease are sparse. Methods and Results-We evaluated sex-and race-stratified cholesterol, blood pressure, and hemoglobin A1c levels and risk factor treatment and control rates in 1580 individuals who self-reported a history of myocardial infarction from The National Health and Nutrition Examination Surveys (NHANES) 1999 to 2012. We used weighted linear regression to estimate time trends and created forward linear projections to 2020. Participants were 30% to 41% women, 73% to 85% white, and had a mean age of 63 to 66 years. Cholesterol treatment rates increased and reached above 80% in men and women by 2011-2012, with significant increases in control rates (as then defined) in men to 85% in 2011-2012, with projections to reach 100% by 2020. Cholesterol treatment rates significantly increased in non-Hispanic whites and Hispanics. Statin use increased significantly to 73% of myocardial infarction survivors by 2011-2012, and aspirin use increased significantly but only to 28% by 2011-2012. There were no changes in blood pressure treatment or control rates by sex, and hypertension treatment increased only in non-Hispanic blacks. Projected hypertension control rates remained suboptimal. Conclusions-While temporal trends suggest improvements in cholesterol treatment, unchanged treatment and control of blood pressure and persistently low aspirin use represent missed opportunities. Urgent action is needed to improve secondary prevention rates projected by 2020 to reduce recurrent events in this high-risk group.