Original Article

Nationwide Trends in Prevalent Cardiovascular Risk Factors and Diseases in Young Adults: Differences by Sex and Race and In-Hospital Outcomes

Authors: Rupak Desai, MBBS, Upenkumar Patel, MBBS, MPH, Tarang Parekh, MBBS, MSc, Bishoy Hanna, MD, Kranthi Sitammagari, MD, Hee Kong Fong, MD, Muhammad Uzair Lodhi, MD, BSc, Yash Varma, MBBS, Nanush Damarlapally, MBBS, Rajkumar Doshi, MD, MPH, Sejal Savani, MPH, Gautam Kumar, MD, Rajesh Sachdeva, MD


Objectives: Prevalence and trends in all cardiovascular disease (CVD) risk factors among young adults (18–39 years) have not been evaluated on a large scale stratified by sex and race. The aim of this study was to establish the prevalence and temporal trend of CVD risk factors in US inpatients younger than 40 years of age from 2007 through 2014 with racial and sex-based distinctions. In addition, the impact of these risk factors on inpatient outcomes and healthcare resource utilization was explored.

Methods: A cross-sectional nationwide analysis of all hospitalizations, comorbidities, and complications among young adults from 2007 to 2014 was performed. The primary outcomes were frequency, trends, and race- and sex-based differences in coexisting CVD risk factors. Coprimary outcomes were trends in all-cause mortality, acute myocardial infarction, arrhythmia, stroke, and venous thromboembolism in young adults with CVD risk factors. Secondary outcomes were demographics and resource utilization in young adults with versus without CVD risk factors.

Results: Of 63 million hospitalizations (mean 30.5 [standard deviation 5.9] years), 27% had at least one coexisting CVD risk factor. From 2007 to 2014, admission frequency with CVD risk factors increased from 42.8% to 55.1% in males and from 16.2% to 24.6% in females. Admissions with CVD risk were higher in male (41.4% vs 15.9%) and white (58.4% vs 53.8%) or African American (22.6% vs 15.9%) patients compared with those without CVD risk. Young adults in the Midwest (23.9% vs 21.1%) and South (40.8% vs 37.9%) documented comparatively higher hospitalizations rates with CVD risk. Young adults with CVD risk had higher all-cause in-hospital mortality (0.4% vs. 0.3%) with a higher average length of stay (4.3 vs 3.2 days) and charges per admission ($30,074 vs $20,124).

Conclusions: Despite modern advances in screening, management, and interventional measures for CVD, rising trends in CVD risk factors across all sex and race/ethnic groups call for attention by preventive cardiologists.
Posted in: Cardiovascular Disease22

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.


1. Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics-2011 update: a report from the American Heart Association. Circulation 2011;123:e18-e209.
2. Doughty M, Mehta R, Bruckman D, et al. Acute myocardial infarction in the young-the University of Michigan experience. Am Heart J 2002;143:56-62.
3. Fournier JA, Sánchez A, Quero J, et al. Myocardial infarction in men aged 40 years or less: a prospective clinical-angiographic study. Clin Cardiol 1996;19:631-636.
4. Greenland P, Reicher-Reiss H, Goldbourt U, et al. In-hospital and 1-year mortality in 1,524 women after myocardial infarction. Comparison with 4,315 men. Circulation 1991;83:484-491.
5. Kannel WB, Abbott RD. Incidence and prognosis of unrecognized myocardial infarction. An update on the Framingham study. N Engl J Med 1984;311:1144-1147.
6. McGill HC, Jr McMahan CA, Zieske AW, et al. Association of coronary heart disease risk factors with microscopic qualities of coronary atherosclerosis in youth. Circulation 2000;102:374-379.
7. Andersson C, Vasan RS. Epidemiology of cardiovascular disease in young individuals. Nat Rev Cardiol 2018;15:230-240.
8. Pletcher MJ, Vittinghoff E, Thanataveerat A, et al. Young adult exposure to cardiovascular risk factors and risk of events later in life: the Framingham Offspring Study. PLoS One 2016;11:e0154288.
9. Tran DM, Zimmerman LM. Cardiovascular risk factors in young adults: a literature review. J Cardiovasc Nurs 2015;30:298-310.
10. Bucholz EM, Gooding HC, de Ferranti SD. Awareness of cardiovascular risk factors in U.S. young adults aged 18-39 years. Am J Prev Med 2018;54:e67-e77.
11. Healthcare Cost and Utilization Project. NIS overview. www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed April 4, 2020.
12. Zhang Y, Moran AE. Trends in the prevalence, awareness, treatment, and control of hypertension among young adults in the United States, 1999 to 2014. Hypertension 2017;70:736-742.
13. Desai R, Parekh T, Singh S, et al. Alarming increasing trends in hospitalizations and mortality with Heyde's syndrome: a nationwide inpatient perspective (2007 to 2014). Am J Cardiol 2019;123:1149-1155.
14. Desai R, Parekh T, Goyal H, et al. Impact of gout on in-hospital outcomes of acute coronary syndrome-related hospitalizations and revascularizations: insights from the national inpatient sample. World J Cardiol 2019;11:137-148.
15. Healthcare Cost and Utilization Project. Clinical Classifications Software (CCS) for ICD-9-CM. www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp. Accessed March 2017.
16. Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents. Summary report. Pediatrics 2011;128(suppl 5):S213-S256.
17. National Center for Chronic Disease Prevention and Health Promotion, Division of Diabetes Translation. National Diabetes Statistics Report, 2017. Estimates of diabetes and its burden in the United States, 2017. https://dev.diabetes.org/sites/default/files/2019-06/cdc-statistics-report-2017.pdf. Accessed April 4, 2020.
18. Lin KW, Brown TR. Screening for lipid disorders in adults: recommendation statement. Am Fam Physician 2009;80:1273-1274.
19. Guenther PM, Dodd KW, Reedy J, et al. Most Americans eat much less than recommended amounts of fruits and vegetables. J Am Diet Assoc 2006;106:1371-1379.
20. Nelson MC, Story M, Larson NI, et al. Emerging adulthood and college-aged youth: an overlooked age for weight-related behavior change. Obesity (Silver Spring) 2008;16:2205-2211.
21. Duangtep Y, Narksawat K, Chongsuwat R, et al. Association between an unhealthy lifestyle and other factors with hypertension among hill tribe populations of Mae Fah Luang District, Chiang Rai Province, Thailand. Southeast Asian J Trop Med Public Health 2010;41:726-734.
22. Pelletier JE, Graham DJ, Laska MN. Social norms and dietary behaviors among young adults. Am J Health Behav 2014;38:144-152.
23. Caspard H, Jabbour S, Hammar N, et al. Recent trends in the prevalence of type 2 diabetes and the association with abdominal obesity lead to growing health disparities in the USA: an analysis of the NHANES surveys from 1999 to 2014. Diabetes Obes Metab 2018;20:667-671.
24. Lascar N, Brown J, Pattison H, et al. Type 2 diabetes in adolescents and young adults. Lancet Diabetes Endocrinol 2018;6:69-80.
25. Gu A, Kamat S, Argulian E. Trends and disparities in statin use and low-density lipoprotein cholesterol levels among US patients with diabetes, 1999-2014. Diabetes Res Clin Pract 2018;139:1-10.
26. Rodriguez CJ, Daviglus ML, Swett K, et al. Dyslipidemia patterns among Hispanics/Latinos in the United States of diverse background. Am J Med 2014;127:1186-1194.e1.
27. Flegal KM, Kruszon-Moran D, Carroll MD, et al. Trends in obesity among adults in the United States, 2005 to 2014. JAMA 2016;315:2284-2291.
28. Freeman C, Fox MA. Status and Trends in the Education of American Indians and Alaska Natives. NCES 2005-108. Washington, DC:National Center for Education Statistics;2005.
29. Zheng Y, Manson JE, Yuan C, et al. Associations of weight gain from early to middle adulthood with major health outcomes later in life. JAMA 2017;318:255-269.
30. Odani S. Prevalence and disparities in tobacco product use among American Indians/Alaska Natives-United States, 2010-2015. MMWR Morb Mortal Wkly Rep 2017;66:1374-1378.
31. Wang TW, Asman K, Gentzke AS, et al. Tobacco product use among adults-United States, 2017. MMWR Morb Mortal Wkly Rep 2018;67:1225-1232.
32. Allen AM, Oncken C, Hatsukami D. Women and smoking: the effect of gender on the epidemiology, health effects, and cessation of smoking. Curr Addict Rep 2014;1:53-60.
33. Ambrose JA, Barua RS. The pathophysiology of cigarette smoking and cardiovascular disease: an update. J Am Coll Cardiol 2004;43:1731-1737.
34. Lane JS, Vittinghoff E, Lane KT, et al. Risk factors for premature peripheral vascular disease: results for the National Health and Nutritional Survey, 1999-2002. J Vasc Surg 2006;44:319-325.
35. Valentine RJ, Jackson MR, Modrall JG, et al. The progressive nature of peripheral arterial disease in young adults: a prospective analysis of white men referred to a vascular surgery service. J Vasc Surg 1999;30:436-444.
36. Guo X, Li Z, Vittinghoff E, et al. Trends in rate of acute myocardial infarction among patients aged 㰰 years. Nat Rev Cardiol 2018;15:119.
37. Gupta A, Wang Y, Spertus JA, et al. Trends in acute myocardial infarction in young patients and differences by sex and race, 2001 to 2010. J Am Coll Cardiol 2014;64:337-345.
38. Stamler J, Stamler R, Neaton JD, et al. Low risk-factor profile and long-term cardiovascular and noncardiovascular mortality and life expectancy: findings for 5 large cohorts of young adult and middle-aged men and women. JAMA 1999;282:2012-2018.
39. Lloyd-Jones DM, Hong Y, Labarthe D, et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association' strategic Impact Goal through 2020 and beyond. Circulation 2010;121:586-613.
40. Greenland P, Alpert JS, Beller GA, et al. 2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2010;122:2748-2764.
41. Navar-Boggan AM, Pencina MJ, Williams K, et al. Proportion of US adults potentially affected by the 2014 hypertension guideline. JAMA 2014;311:1424-1429.
42. Schofield J, Ho J, Soran H. Cardiovascular risk in type 1 diabetes mellitus. Diabetes Ther 2019;10:773-789.
43. Coulson EJ, Ng WF, Goff I, et al. Cardiovascular risk in juvenile idiopathic arthritis. Rheumatology (Oxford) 2013;52:1163-1171.