Cardiovascular Risk Factor Control and Adherence to Recommended Lifestyle and Medical Therapies in Persons With Coronary Heart Disease (from the National Health and Nutrition Examination Survey 2007–2010)

Persons with known coronary heart disease (CHD) are at a greater risk of subsequent events. The current guidelines for secondary prevention have focused on lifestyle modifications, risk factor control, and drug therapy. However, current data lack information on the United States population and its adherence to these guidelines. Using data from the National Health and Nutrition Examination Survey from 2007 to 2010, we identified those with CHD and assessed the adequacy of their adherence to the current guidelines for secondary prevention. Of 759 subjects with CHD (weighted to 12.7 million), the use of recommended therapies was 55%, 45%, and 62% for β blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and lipid-lowering agents, respectively (24% for all), with adherence lower in women than in men and in blacks and Hispanics than in whites. The nonsmoking status and control of blood pressure, low-density lipoprotein cholesterol, and, for those with diabetes, glycated hemoglobin was 73%, 67%, 59%, 60%, respectively (14% for all). Also, 17%, 70%, and 7% were at the recommended levels for physical activity, alcohol consumption, and sodium intake, respectively. Moreover, only 20% and 29% were at the recommended body mass index and waist circumference targets, respectively. Those with metabolic syndrome and diabetes were more likely to have ≥2 risk factors uncontrolled, despite being more likely to be receiving recommended therapies. A significant gap still exists between the secondary prevention guidelines and their adherence and control of CHD risk factors among United States adults. In conclusion, greater efforts are needed to ensure adherence to all aspects of secondary prevention guidelines to optimize the prognosis in subjects with CHD.