Recent changes in cardiovascular risk factors among women and men

Background: The purpose of this study was to examine change over the 1990s in the proportion of men and women with measured high-risk values of cardiovascular risk factors. Methods: Change in the prevalence of high-risk conditions based on clinical cutoffs for 10 cardiovascular risk factors was assessed in respondents aged >= 40 from the nationally representative, cross-sectional National Health and Nutrition Examination Surveys ( NHANES) III (1988-1994) and IV (1999-2002). Results: Both sexes experienced a reduction in the prevalence of high-risk levels of cholesterol ( total, high-density lipoprotein [HDL], and low-density lipoprotein [LDL]) and high homocysteine and an increase in obesity and high C-reactive protein (CRP). Changes in the prevalence of high total cholesterol and high CRP were more pronounced among women. The percentage of women with high diastolic and systolic blood pressure increased, whereas this percentage decreased among men. During the same time, there was an increase in undiagnosed high blood pressure and in the use of antihypertensive medications without achieving adequate blood pressure control among women. Both sexes increased their use of cholesterol-lowering medication. These changes in diagnosis rates and medication usage did not explain the trends in the prevalence of high-risk blood pressure or high-risk cholesterol, although the larger increase in high CRP among women is related to increased use of postmenopausal hormone therapy over the 1990s. Conclusions: We found mixed trends in cardiovascular risk factors for both women and men; some improved and some deteriorated. Changes in medication use and obesity did not explain these trends.