Awareness of Cardiovascular Risk Factors in U.S. Young Adults Aged 18–39 Years

Published:February 09, 2018DOI:


      Young adults with hyperlipidemia, hypertension, and diabetes are at increased risk of developing heart disease later in life. Despite emphasis on early screening, little is known about awareness of these risk factors in young adulthood.


      Data from the nationally representative cross-sectional National Health and Nutrition Examination Survey 2011–2014 were analyzed in 2017 to estimate the prevalence of self-reported awareness of hypercholesterolemia, hypertension, and diabetes in U.S. young adults aged 18–39 years (n=11,083). Prevalence estimates were weighted to population estimates using survey procedures, and predictors of awareness were identified using weighted logistic regression.


      Among U.S. young adults, the prevalence of hypercholesterolemia, hypertension, and diabetes was 8.8% (SE=0.4%); 7.3% (SE=0.3%); and 2.6% (SE=0.2%), respectively. The prevalence of borderline high cholesterol, blood pressure, and blood glucose were substantially higher (21.6% [SE= 0.6%]; 26.9% [SE=0.7%]; and 18.9% [SE=0.6%], respectively). Awareness was low for hypercholesterolemia (56.9% [SE=2.4%]) and moderate for hypertension and diabetes (62.7% [SE=2.4%] and 70.0% [SE=2.7%]); <25% of young adults with borderline levels of these risk factors were aware of their risk. Correlates of risk factor awareness included older age, insurance status, family income above the poverty line, U.S. origin, having a usual source of health care, and the presence of comorbid conditions.


      Despite the high prevalence of cardiovascular risk factors in U.S. young adults, awareness remains less than ideal. Interventions that target access may increase awareness and facilitate achieving treatment goals in young adults.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Berenson G.S.
        • Srinivasan S.R.
        • Bao W.
        • Newman 3rd, W.P.
        • Tracy R.E.
        • Wattigney W.A.
        Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults.
        N Engl J Med. 1998; 338: 1650-1656
        • Berenson G.S.
        • Wattigney W.A.
        • Tracy R.E.
        • et al.
        Atherosclerosis of the aorta and coronary arteries and cardiovascular risk factors in persons aged 6 to 30 years and studied at necropsy (The Bogalusa Heart Study).
        Am J Cardiol. 1992; 70: 851-858
        • Li S.
        • Chen W.
        • Srinivasan S.R.
        • et al.
        Childhood cardiovascular risk factors and carotid vascular changes in adulthood: the Bogalusa Heart Study.
        JAMA. 2003; 290: 2271-2276
        • Loria C.M.
        • Liu K.
        • Lewis C.E.
        • et al.
        Early adult risk factor levels and subsequent coronary artery calcification: the CARDIA Study.
        J Am Coll Cardiol. 2007; 49: 2013-2020
        • McGill Jr., H.C.
        • McMahan C.A.
        • Gidding S.S.
        Preventing heart disease in the 21st century: implications of the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) study.
        Circulation. 2008; 117: 1216-1227
        • Navar-Boggan A.M.
        • Peterson E.D.
        • D’Agostino Sr., R.B.
        • Neely B.
        • Sniderman A.D.
        • Pencina M.J.
        Hyperlipidemia in early adulthood increases long-term risk of coronary heart disease.
        Circulation. 2015; 131: 451-458
        • Pletcher M.J.
        • Bibbins-Domingo K.
        • Liu K.
        • et al.
        Nonoptimal lipids commonly present in young adults and coronary calcium later in life: the CARDIA study.
        Ann Intern Med. 2010; 153: 137-146
        • Pletcher M.J.
        • Vittinghoff E.
        • Thanataveerat A.
        • Bibbins-Domingo K.
        • Moran A.E.
        Young adult exposure to cardiovascular risk factors and risk of events later in life: the Framingham Offspring Study.
        PloS One. 2016; 11: e0154288
        • Raynor L.A.
        • Schreiner P.J.
        • Loria C.M.
        • Carr J.J.
        • Pletcher M.J.
        • Shikany J.M.
        Associations of retrospective and concurrent lipid levels with subclinical atherosclerosis prediction after 20 years of follow-up: the Coronary Artery Risk Development in Young Adults (CARDIA) study.
        Ann Epidemiol. 2013; 23: 492-497
        • Stamler J.
        • Stamler R.
        • Neaton J.D.
        • 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
        • Stamler J.
        • Dyer A.R.
        • Shekelle R.B.
        • Neaton J.
        • Stamler R.
        Relationship of baseline major risk factors to coronary and all-cause mortality, and to longevity: findings from long-term follow-up of Chicago cohorts.
        Cardiology. 1993; 82: 191-222
        • Burke G.L.
        • Arnold A.M.
        • Bild D.E.
        • et al.
        Factors associated with healthy aging: the cardiovascular health study.
        J Am Geriatr Soc. 2001; 49: 254-262
      1. Integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report.
        National Heart, Lung, and Blood Institute, Bethesda, MD2012
      2. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report.
        Pediatrics. 2011; 128: S213-S256
        • Lin K.W.
        • Brown T.R.
        Screening for lipid disorders in adults.
        Am Fam Physician. 2009; 80: 1281-1282
      3. U.S. Preventive Services Task Force. Final update summary: lipid disorders in adults (cholesterol, dyslipidemia): screening. Published 2008.

        • Casagrande S.S.
        • Menke A.
        • Cowie C.C.
        Cardiovascular risk factors of adults age 20–49 years in the United States, 1971–2012: a series of cross-sectional studies.
        PLoS One. 2016; 11: e0161770
        • Cheung B.M.
        • Ong K.L.
        • Man Y.B.
        • Lam K.S.
        • Lau C.P.
        Prevalence, awareness, treatment, and control of hypertension: United States National Health and Nutrition Examination Survey 2001–2002.
        J Clin Hypertension. 2006; 8: 93-98
        • Cutler J.A.
        • Sorlie P.D.
        • Wolz M.
        • Thom T.
        • Fields L.E.
        • Roccella E.J.
        Trends in hypertension prevalence, awareness, treatment, and control rates in United States adults between 1988–1994 and 1999–2004.
        Hypertension. 2008; 52: 818-827
        • Kuklina E.V.
        • Yoon P.W.
        • Keenan N.L.
        Prevalence of coronary heart disease risk factors and screening for high cholesterol levels among young adults, United States, 1999–2006.
        Ann Fam Med. 2010; 8: 327-333
        • Ong K.L.
        • Cheung B.M.
        • Man Y.B.
        • Lau C.P.
        • Lam K.S.
        Prevalence, awareness, treatment, and control of hypertension among United States adults 1999–2004.
        Hypertension. 2007; 49: 69-75
        • Ayanian J.Z.
        • Zaslavsky A.M.
        • Weissman J.S.
        • Schneider E.C.
        • Ginsburg J.A.
        Undiagnosed hypertension and hypercholesterolemia among uninsured and insured adults in the Third National Health and Nutrition Examination Survey.
        Am J Public Health. 2003; 93: 2051-2054
        • Cowie C.C.
        • Rust K.F.
        • Byrd-Holt D.D.
        • et al.
        Prevalence of diabetes and impaired fasting glucose in adults in the U.S. population: National Health and Nutrition Examination Survey 1999–2002.
        Diabetes Care. 2006; 29: 1263-1268
        • Ford E.S.
        • Mokdad A.H.
        • Giles W.H.
        • Mensah G.A.
        Serum total cholesterol concentrations and awareness, treatment, and control of hypercholesterolemia among U.S. adults: findings from the National Health and Nutrition Examination Survey, 1999 to 2000.
        Circulation. 2003; 107: 2185-2189
        • Gooding H.C.
        • McGinty S.
        • Richmond T.K.
        • Gillman M.W.
        • Field A.E.
        Hypertension awareness and control among young adults in the national longitudinal study of adolescent health.
        J Gen Intern Med. 2014; 29: 1098-1104
        • McDonald M.
        • Hertz R.P.
        • Unger A.N.
        • Lustik M.B.
        Prevalence, awareness, and management of hypertension, dyslipidemia, and diabetes among United States adults aged 65 and older.
        J Gerontol. 2009; 64: 256-263
        • Muntner P.
        • Levitan E.B.
        • Brown T.M.
        • et al.
        Trends in the prevalence, awareness, treatment and control of high low density lipoprotein-cholesterol among United States adults from 1999–2000 through 2009–2010.
        Am J Cardiol. 2013; 112: 664-670
        • Stone N.J.
        • Robinson J.G.
        • Lichtenstein A.H.
        • et al.
        2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.
        Circulation. 2014; 129: S1-S45
        • Benjamin E.J.
        • Blaha M.J.
        • Chiuve S.E.
        • et al.
        Heart disease and stroke statistics—2017 update: a report from the American Heart Association.
        Circulation. 2017; 135: e146-e603
        • Brown T.M.
        • Tanner R.M.
        • Carson A.P.
        • et al.
        Awareness, treatment, and control of LDL cholesterol are lower among U.S. adults with undiagnosed diabetes versus diagnosed diabetes.
        Diabetes Care. 2013; 36: 2734-2740
      4. Medicaid and CHIP eligibility levels. Published 2016. Accessed February 24, 2017.

        • Johnson C.L.
        • Paulose-Ram R.
        • Ogden C.L.
        • et al.
        National Health and Nutrition Examination Survey: analytic guidelines, 1999–2010.
        Vital Health Stat 2. 2013; 161: 1-24
        • Christian J.B.
        • Bourgeois N.E.
        • Lowe K.A.
        Cholesterol screening in U.S. adults and awareness of high cholesterol among individuals with severe hypertriglyceridemia: National Health and Nutrition Examination Survey 2001–2008.
        J Cardiovasc Nurs. 2015; 30: 26-34
        • Fowler-Brown A.
        • Corbie-Smith G.
        • Garrett J.
        • Lurie N.
        Risk of cardiovascular events and death—does insurance matter?.
        J Gen Intern Med. 2007; 22: 502-507
        • Kaplan G.A.
        • Keil J.E.
        Socioeconomic factors and cardiovascular disease: a review of the literature.
        Circulation. 1993; 88: 1973-1998
        • Mensah G.A.
        • Mokdad A.H.
        • Ford E.S.
        • Greenlund K.J.
        • Croft J.B.
        State of disparities in cardiovascular health in the United States.
        Circulation. 2005; 111: 1233-1241
        • Arnold S.V.
        • Spertus J.A.
        • Tang F.
        • et al.
        Statin use in outpatients with obstructive coronary artery disease.
        Circulation. 2011; 124: 2405-2410
        • Smolderen K.G.
        • Spertus J.A.
        • Tang F.
        • et al.
        Treatment differences by health insurance among outpatients with coronary artery disease: insights from the National Cardiovascular Data Registry.
        J Am Coll Cardiol. 2013; 61: 1069-1075
        • Brooks E.L.
        • Preis S.R.
        • Hwang S.J.
        • et al.
        Health insurance and cardiovascular disease risk factors.
        Am J Med. 2010; 123: 741-747
        • American Diabetes Association. 8
        Cardiovascular disease and risk management.
        Diabetes Care. 2015; 38: S49-S57
        • Sharma S.
        • Malarcher A.M.
        • Giles W.H.
        • Myers G.
        Racial, ethnic, and socioeconomic disparities in the clustering of cardiovascular risk factors.
        Ethn Dis. 2004; 14: 43-48
        • Elmer P.J.
        • Grimm Jr., R.
        • Laing B.
        • et al.
        Lifestyle intervention: results of the Treatment of Mild Hypertension Study (TOMHS).
        Prev Med. 1995; 24: 378-388
        • Knowler W.C.
        • Barrett-Connor E.
        • Fowler S.E.
        • et al.
        Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.
        N Engl J Med. 2002; 346: 393-403
        • Sacks F.M.
        • Svetkey L.P.
        • Vollmer W.M.
        • et al.
        Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group.
        N Engl J Med. 2001; 344: 3-10
        • Tuomilehto J.
        • Lindstrom J.
        • Eriksson J.G.
        • et al.
        Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance.
        N Engl J Med. 2001; 344: 1343-1350
        • Whelton S.P.
        • Chin A.
        • Xin X.
        • He J.
        Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials.
        Ann Intern Med. 2002; 136: 493-503
        • Whelton P.K.
        • Carey R.M.
        • Aronow W.S.
        • et al.
        2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults.
        Hypertension. In press. Online November 13,. 2017; (
        • Vinci S.R.
        • Rifas-Shiman S.L.
        • Cheng J.K.
        • Mannix R.C.
        • Gillman M.W.
        • de Ferranti S.D.
        Cholesterol testing among children and adolescents during health visits.
        JAMA. 2014; 311: 1804-1807
        • Fortuna R.J.
        • Robbins B.W.
        • Halterman J.S.
        Ambulatory care among young adults in the United States.
        Ann Intern Med. 2009; 151: 379-385