NCHS Data Brief ■ No. 103 ■ August 2012

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Prevalence of Uncontrolled Risk Factors for 

Cardiovascular Disease: United States, 1999–2010

Cheryl D. Fryar, M.S.P.H.; Te-Ching Chen, Ph.D.; and Xianfen Li, M.S.

Key findings

Data from the National 

Health and Nutrition 

Examination Survey

•	 In 2009–2010, about 47% of 

adults had at least one of three 

risk factors for cardiovascular 

disease—uncontrolled high 

blood pressure, uncontrolled 

high levels of low-density 

lipoproteins (LDL) cholesterol, 

or current smoking.

•	 Men were more likely than 

women to have at least one of 

the three cardiovascular disease 

risk factors.

•	 From 1999–2000 through 

2009–2010, a decrease was 

observed in the percentage 

of non-Hispanic white and 

Mexican-American adults who 

had at least one of the three 

risk factors for cardiovascular 

disease. However, this decrease 

was not found among nonHispanic black adults.

•	 The prevalence of 

uncontrolled high blood 

pressure and of uncontrolled 

high LDL cholesterol declined 

between 1999–2000 and 2009–

2010,	but	no	significant	change	

occurred in the percentage of 

adults who smoke cigarettes.

Heart disease is the leading cause of death in the United States (1). High blood 

pressure, high cholesterol, and smoking are all risk factors that could lead to 

cardiovascular disease (CVD) and stroke. The recently announced Million 

Hearts Initiative is aimed at preventing 1 million heart attacks and strokes over 

the next 5 years (2–4). This report expands on results previously published (2) 

by presenting the most recent prevalence estimates and trends of uncontrolled 

high blood pressure, uncontrolled high levels of low-density lipoproteins 

cholesterol (LDL-C), and current cigarette smoking among adults aged 20 

and over.

Keywords: uncontrolled high blood pressure • uncontrolled high cholesterol •

smoking • National Health and Nutrition Examination Survey

Did the percentage of adults who have at least one of three 

CVD risk factors change from 1999 through 2010?

During 1999–2010, a decreasing trend was observed in the percentage of 

adults with at least one of three risk factors for CVD, from 57.8% (about Percent

0

30

40

50

60

70

80

2009–10

1999–2000 2003–04 2007–08

Aged 60 and over

40–59

Total

20–39

0

30

40

50

60

70

80

2009–10

1999–2000 2003–04 2007–08

Aged 60 and over

40–59

Total

20–39

Men1,2 Women3,4

Figure 1. Age-adjusted percentage of adults aged 20 and over who have uncontrolled high

blood pressure or uncontrolled high LDL cholesterol, or who currently smoke, by sex and age:

United States, 1999–2010

1

Significant decreasing linear trend for age groups 40–59 and 60 and over (p < 0.05). 2

In 2009–2010, significantly different from women. 3

Significant decreasing linear trend for age group 60 and over (p < 0.05). 4

In 2009–2010, women aged 60 and over significantly different from women aged 40–59 and 20–39.

NOTES: Data include participants examined as part of the morning fasting subsample only and exclude pregnant women.

Data are age-adjusted to year 2000 U.S. Census Bureau estimates using age groups 20–39, 40–59, and 60 and over. LDL is

low-density lipoproteins.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 1999–2010.
NCHS Data Brief ■ No. 103 ■ August 2012

■  2  ■

109 million adults) in 1999–2000 to 46.5% (about 102.5 million adults) in 2009–2010 (data not 

shown). This decreasing trend was found among both men and women (Figure 1). Among men, 

this decrease occurred in age groups 40–59 and 60 and over. For women, the decreasing trend 

was found only among those aged 60 and over, from 78.3% in 1999–2000 to 53.9% in 2009–2010.

In 2009–2010, men (51.6%) were more likely than women (41.2%) to have at least one of the 

three risk factors for CVD. Having at least one of three CVD risk factors did not significantly 

differ by age group among men. Women aged 60 and over (53.9%) were more likely to have at 

least one of the three CVD risk factors compared with women aged 40–59 (40.5%) or 20–39 

(34.4%).

During 1999–2010, did the trends in the percentage of adults who have at 

least one of three CVD risk factors vary by race and ethnicity?

From 1999–2000 through 2009–2010, a significant decrease was observed in the percentages 

of non-Hispanic white and Mexican-American adults with at least one of the three risk factors 

for CVD (Figure 2). However, a significant decrease was not found among non-Hispanic black 

adults. Over the 12-year period, the percentage of non-Hispanic black persons with one of three 

CVD risk factors was higher than the percentages of non-Hispanic white or Mexican-American 

persons. In 2009–2010, almost 58% of non-Hispanic black adults had at least one risk factor, 

while about 47% of non-Hispanic white adults and almost 45% of Mexican-American adults had 

at least one of the three risk factors for CVD. Percent

0

30

40

50

60

70

80

1999–2000 2001–2002 2003–2004 2005–2006 2007–2008 2009–2010

Non-Hispanic black1

Non-Hispanic white2

Mexican American2

Figure 2. Age-adjusted percentage of adults aged 20 and over who have uncontrolled high blood pressure or

uncontrolled high LDL cholesterol, or who currently smoke, by race and ethnicity: United States, 1999–2010

1

In 2009–2010, significantly different from non-Hispanic white and Mexican American. 2

Significant decreasing linear trend (p < 0.05).

NOTES: Data include participants examined as part of the morning fasting subsample only and exclude pregnant women. Data are age-adjusted to year

2000 U.S. Census Bureau estimates using age groups 20–39, 40–59, and 60 and over. LDL is low-density lipoproteins. 

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 1999–2010.
NCHS Data Brief ■ No. 103 ■ August 2012

■  3  ■

During 1999–2010, did the trends in the percentage of adults who have at 

least one of three CVD risk factors vary by income?

From 1999–2000 through 2009–2010, the percentage of adults with at least one of the three CVD 

risk factors decreased in all income groups (Figure 3). Over this 12-year period, the percentage 

of adults in the lowest income group with at least one of three CVD risk factors was higher than 

the percentages in the other income groups. In 2009–2010, lower-income adults were more likely 

to have at least one of the three CVD risk factors (60.8%) compared with those in the middleincome (47.2%) and higher-income (37.9%) groups. Middle-income adults were more likely to 

have at least one of three risk factors for CVD compared with higher-income adults. Percent

0

30

40

50

60

70

80

1999–2000 2001–2002 2003–2004 2005–2006 2007–2008 2009–2010

Less than 130%

of poverty level

1

130%–350% 

of poverty level

1

350% or more

of poverty level

1

Figure 3. Age-adjusted percentage of adults aged 20 and over who have uncontrolled high blood pressure or

uncontrolled high LDL cholesterol, or who currently smoke, by income: United States, 1999–2010

1

Significant decreasing linear trend (p < 0.05), and in 2009–2010, all income groups significantly different.

NOTES: Data include participants examined as part of the morning fasting subsample only and exclude pregnant women. Data are age-adjusted to year

2000 U.S. Census Bureau estimates using age groups 20–39, 40–59, and 60 and over. LDL is low-density lipoproteins.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 1999–2010.
NCHS Data Brief ■ No. 103 ■ August 2012

■  4  ■

What are the changes over time for each of the three CVD risk factors 

separately?

Among U.S. adults, the prevalence of both uncontrolled high blood pressure and uncontrolled 

high levels of LDL-C declined between 1999–2000 and 2009–2010 (declines of 7.6 percentage 

points for uncontrolled high blood pressure and 9.3 percentage points for uncontrolled high 

LDL-C) (Figure 4). Over the 12-year period, smoking prevalence did not decrease significantly.

In 2009–2010, among adults aged 20 and over, 25.1% of adults were current smokers, 23.3% had 

uncontrolled high LDL-C, and 11.8% had uncontrolled high blood pressure. Percent

0

20

40

60

80

1999–2000 2001–2002 2003–2004 2005–2006 2007–2008 2009–2010

Current smoker

At lease one risk1

Uncontrolled high LDL cholesterol

1

Uncontrolled high blood pressure1 

Figure 4. Age-adjusted percentage of uncontrolled high blood pressure, uncontrolled high LDL cholesterol, and current 

smoking among adults aged 20 and over: United States, 1999–2010

1

Significant decreasing linear trend (p < 0.05).

NOTES: Data include participants examined as part of the morning fasting subsample only and exclude pregnant women. Data are age-adjusted to year

2000 U.S. Census Bureau estimates using age groups 20–39, 40–59, and 60 and over. LDL is low-density lipoproteins. 

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 1999–2010.
NCHS Data Brief ■ No. 103 ■ August 2012

■  5  ■

Summary

In 2009–2010, approximately 46.5% of U.S. adults aged 20 and over had at least one of three risk 

factors for CVD and stroke. More than one-quarter were current smokers, more than 23% had 

uncontrolled high levels of LDL-C, and almost 12% had uncontrolled high blood pressure. Adults 

who were male, or female aged 60 and over, or non-Hispanic black, or of lower income were 

more likely to have one of the risk factors for CVD compared with their counterparts.

Over the 12-year period from 1999 through 2010, the percentage of adults aged 20 and over with 

uncontrolled high blood pressure or uncontrolled high levels of LDL-C declined. During the same 

time period, the percentage of adults who smoked cigarettes did not decrease significantly.

These findings may provide useful information for monitoring the U.S. adult population for risk

factors that could lead to CVD.

Definitions

Uncontrolled high blood pressure: A measured systolic blood pressure of 140 mm Hg or more, 

or a diastolic blood pressure of 90 mm Hg or more (5), based on an average of up to three 

measurements. Persons defined as having uncontrolled high blood pressure may or may not have

been taking medication.

Uncontrolled high LDL cholesterol (LDL-C): Measured levels of LDL-C above the treatment 

goals established by the National Cholesterol Education Program’s Adult Treatment Panel III 

guidelines: less than 160 mg/dL for low-risk groups, less than 130 mg/dL for intermediate-risk 

groups, and less than 100 mg/dL for high-risk groups (6). Persons defined as having uncontrolled

high LDL-C may or may not have been taking medication.

Smoker: Defined as “current smoker” if the survey participant reported that he or she smoked at

least 100 cigarettes in his or her lifetime and now smokes every day or some days, or based on a 

measured serum cotinine (the primary nicotine metabolite) level greater than 10 ng/mL.

Poverty income ratio: An index representing the ratio of family income to poverty level. The 

U.S. Department of Health and Human Services’ poverty guidelines were the measure used to 

calculate this index (7). The cut point for participation in the Supplemental Nutrition Assistance 

Program is 130% of the poverty level.

Data source and methods

Data from the National Health and Nutrition Examination Survey (NHANES) were used 

for these analyses. NHANES is a cross-sectional survey designed to monitor the health and 

nutritional status of the civilian, noninstitutionalized U.S. population (8). The survey consists of 

interviews conducted in participants’ homes, standardized physical examinations conducted in 

mobile examination centers, and laboratory tests utilizing blood and urine specimens provided 

by participants during the physical examination. LDL-C was calculated for a subsample of 

participants who fasted and were examined in the morning.
NCHS Data Brief ■ No. 103 ■ August 2012

■  6  ■

The NHANES sample is selected through a complex, multistage design that includes selection 

of primary sampling units (counties), household segments within the counties, and, finally,

sample persons from selected households. The sample design includes oversampling to obtain 

reliable estimates of health and nutritional measures for population subgroups. African-American 

persons, Mexican-American persons, those having low income, and persons aged 60 and over 

were oversampled during 1999–2010. Beginning in 2007, all Hispanic persons, rather than only 

Mexican-American persons, were oversampled. However, sampling fractions were set so that the 

sample size for Mexican-American participants would not be very different from previous years 

and would be sufficient to produce reliable estimates for this group (9). NHANES public-use data 

files are released in 2-year cycles.

Persons with missing blood pressure or LDL-C measurements were excluded from this analysis 

(none were missing smoking status). Because serum LDL-C levels were derived for participants 

who were examined in the morning session only, fasting subsample weights—which account for 

the differential probabilities of selection, nonresponse, and noncoverage—were incorporated into 

the estimation process. The standard errors of the percentages were estimated using Taylor series 

linearization, a method that incorporates the sample design (10).

Estimates for the total population were age adjusted to the year 2000 projected U.S. standard 

population using three age groups: 20–39, 40–59, and 60 and over. Differences between groups 

were evaluated using a t statistic at the p < 0.05 significance level with the appropriate degrees of

freedom. All differences reported are statistically significant unless otherwise indicated. To test for

linear trends, the null hypothesis of nonlinear trend was examined using orthogonal polynomials. 

Statistical analyses were conducted using SAS for Windows, release 9.2 (SAS Institute, Cary, 

N.C.), and SUDAAN release 10.0 (RTI International, Research Triangle Park, N.C.).

About the authors

Cheryl D. Fryar is with the Centers for Disease Control and Prevention’s National Center for 

Health Statistics (NCHS), Division of Health and Nutrition Examination Surveys. Te-Ching Chen 

and Xianfen Li are with the Harris Corporation under a contract with NCHS.
NCHS Data Brief ■ No. 103 ■ August 2012

■  7  ■

References

1. Miniño AM. Death in the United States, 2009. NCHS data brief, no 64. Hyattsville, MD: 

National Center for Health Statistics. 2011.

2. CDC. Million Hearts: Strategies to reduce the prevalence of leading cardiovascular disease 

risk factors—United States, 2011. MMWR 60(36):1248–51. 2011.

3. Tomaselli GF, Harty MB, Horton K, Schoeberl M. The American Heart Association and 

the Million Hearts Initiative: A presidential advisory from the American Heart Association. 

Circulation 124(16):1795–9. 2011. Available from: http://circ.ahajournals.org/content/

early/2011/09/12/CIR.0b013e3182327084.

4. Frieden TR, Berwick DM. The “Million Hearts” Initiative—Preventing heart attacks and

strokes. N Engl J Med 365(13):e27. 2011.

5. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. The seventh 

report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of 

High Blood Pressure. Hypertension 42(6):1206–52. 2003.

6. National Institutes of Health. Third report of the National Cholesterol Education Program 

(NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in 

Adults (Adult Treatment Panel III). NIH 02–5215. Washington, DC. 2002. 

7. U.S. Department of Health and Human Services, Assistant Secretary for Planning and 

Evaluation. Poverty guidelines, research, and measurement. Washington, DC. 2011. Available 

from: http://aspe.hhs.gov/POVERTY/index.shtml. 

8. National Center for Health Statistics. National Health and Nutrition Examination Surveys 

1999–2010. Available from: http://www.cdc.gov/nchs/nhanes/nhanes_questionnaires.htm.

9. National Center for Health Statistics. Analytic note regarding 2007–2010 survey design 

changes and combining data across other survey cycles. Hyattsville, MD. Available from: 

http://www.cdc.gov/nchs/data/nhanes/analyticnote_2007-2010.pdf [Accessed July 23, 2012].

10. National Center for Health Statistics. The National Health and Nutrition Examination Survey 

(NHANES) analytic and reporting guidelines. Available from: http://www.cdc.gov/nchs/nhanes/

nhanes2003-2004/analytical_guidelines.htm [Accessed July 23, 2012].
NCHS Data Brief ■ No. 103 ■ August 2012

Suggested citation

Fryar CD, Chen T, Li X. Prevalence of 

uncontrolled risk factors for cardiovascular 

disease: United States, 1999–2010. 

NCHS data brief, no 103. Hyattsville, MD: 

National Center for Health Statistics. 2012.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Edward J. Sondik, Ph.D., Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Health and Nutrition 

Examination Surveys

Clifford L. Johnson, M.S.P.H., Director

For e-mail updates on NCHS publication 

releases, subscribe online at: 

http://www.cdc.gov/nchs/govdelivery.htm.

For questions or general information

about NCHS:

Tel: 1–800–232–4636

E-mail: cdcinfo@cdc.gov

Internet: http://www.cdc.gov/nchs

ISSN 1941–4927 (Print ed.)

ISSN 1941–4935 (Online ed.)

CS234281

DHHS Publication No. (PHS) 2012–1209

U.S. DEPARTMENT OF

HEALTH & HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

3311 Toledo Road

Hyattsville, MD 20782

OFFICIAL BUSINESS 

PENALTY FOR PRIVATE USE, $300

FIRST CLASS MAIL 

POSTAGE & FEES PAID 

CDC/NCHS

PERMIT NO. G-284