Peak heart health is rare in the U.S.—and increasingly uncommon. A new study published in the Journal of the American College of Cardiology finds that fewer than 7% of all American adults have optimal health across five major areas related to heart and metabolic health: weight, blood sugar, blood pressure, cholesterol, and cardiovascular disease status. And the problem is getting worse.
These five categories were adapted from the American Heart Association’s definition of ideal cardiovascular and metabolic health. The study, which analyzed National Health and Nutrition Examination Survey data from more than 55,000 people over age 20, found that most Americans have at least one cardiometabolic risk factor—conditions like being overweight and having had a past heart attack, heart failure, or stroke, which raise the risk of problems like heart disease and Type 2 diabetes.
The researchers also found that cardiometabolic health keeps declining over time. (Surveys included in the study were conducted annually 1999 to 2000 from 2017 and 2018.) The researchers identified two big factors driving this decline: a rise in the proportion of people who are overweight or obese, along with rising glucose levels in the population. The most recent data included in the study found that less than a quarter of Americans had a normal body mass index (BMI) and waist circumference—down from 34%—while only 37% had healthy glucose levels, down from 59%.
Another major concern is that risk isn’t equally distributed across the population. While the number of white adults with optimal cardiometabolic health rose slightly over time, the rate declined somewhat among other races. And overall, Americans who are male, Black, Mexican American, or older are generally less likely to be in optimal cardiometabolic health than people with other demographic characteristics. Education status also seemed to be a factor. Only 5% of U.S. adults with lower education had optimal cardiometabolic health, for example, compared to 10% of people with higher education.
“We were definitely surprised by the magnitude of the problem,” says Meghan O’Hearn, a doctoral candidate at the Friedman School of Nutrition Science and Policy at Tufts University, who co-authored the research. “That’s a pretty dismal situation, and it’s only gotten worse over the last 20 years.”
While their findings were disturbing, O’Hearn emphasized that they should be a “call to action” for policymakers, who can improve access to healthy food through expanding the Supplemental Nutrition Assistance Program, reallocating agricultural subsidies and incentives toward groups that produce more nutritious options, and prioritizing health education, she says.
Individuals can also improve their cardiometabolic health by eating a well-balanced diet rich in fruits, vegetables, nuts, beans, seeds, legumes, and healthy fats, and becoming more physically active, says O’Hearn. The American Heart Association also offers a checklist of behaviors critical to optimal health; in June, the group added getting sufficient sleep—7 to 9 hours of sleep per night—to the list for the first time.
Improving cardiometabolic health is worthwhile physically and even financially, since the U.S. spends billions of dollars annually in diet-related healthcare costs and loses billions in workforce productivity each year. For individuals, however, the value is priceless: the opportunity to have a longer life free of chronic disease.
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