Shifts in Metabolic Biomarkers Related to Cardiovascular Disease and Diabetes from 2013 to 2023: A Decade of Change, Including the COVID-19 Era
Authors: Fang Caishan , Qi Xiangjun , Yuan Tianhui , Zhu Zhaohua , Li Jiaojiao , Zhang Qinxiu , Jia Jie , Sun Jing 
Published: January 2025

IMPORTANCE Understanding trends in cardiovascular and diabetes-related metabolic biomarkers across populations, especially during the COVID-19 pandemic, is essential for informing public health strategies targeting the prevention and management of cardiovascular diseases (CVD) and diabetes. This study aimed to assess trends in cardiovascular and diabetes-related metabolic biomarkers among U.S. adults from 2013-2014 to 2021-2023.
DESIGN, SETTING, AND PARTICIPANTS This study analyzed five cycles of cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) spanning 2013-2014 to 2021-2023. The sample was weighted to reflect the noninstitutionalized civilian U.S. population aged 18 and older. Data analysis was conducted from August to October 2024.
EXPOSURES Calendar year and sociodemographic subgroups, including age, gender, race, educational level, and family poverty-to-income ratio.
MAIN OUTCOMES AND MEASURES Primary outcomes included body mass index (BMI), waist circumference, body fat percentage, systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse rate, estimated pulse wave velocity (ePWV), fasting glucose, glycohemoglobin, total fasting cholesterol, high-density lipoprotein cholesterol (HDL-C), fasting insulin, and insulin resistance index. Trends were estimated using survey-weighted linear regression models.
RESULTS A total of 10,337 participants were included. BMI, waist circumference, and body fat percentage showed significant increases (all P for trend < 0.05). Specifically, BMI increased from 28.54 kg/m² (95% CI: 28.18-28.91) to 29.43 kg/m² (95% CI: 28.85-30.01); waist circumference rose from 97.63 cm (95% CI: 96.86-98.40) to 100.11 cm (95% CI: 98.77-101.44); and body fat percentage increased from 33.59% (95% CI: 31.11-34.07%) to 35.68% (95% CI: 34.90-36.46%). Significant interactions for these biomarkers were observed among various education and income subgroups. DBP (P < 0.0001) and ePWV (P < 0.0001) also increased, with DBP rising from 68.01 mmHg (95% CI: 67.42-68.60) to 74.17 mmHg (95% CI: 73.29-76.06) and ePWV from 7.89 m/s (95% CI: 7.75-8.02) to 8.41 m/s (95% CI: 8.27-8.55), while pulse rate declined from 72.27 bpm (95% CI: 71.17-73.37) to 70.59 bpm (95% CI: 69.96-71.23) (P < 0.0001). Although SBP did not show an overall significant trend, increases were observed among men (from 121.06 mmHg [95% CI: 119.87-122.25] to 123.27 mmHg [95% CI: 122.41-124.12], P for trend = 0.005) and individuals with less than a high school education (from 117.56 mmHg [95% CI: 115.77-119.34] to 124.55 mmHg [95% CI: 121.81-127.30], Pfor trend < 0.0001). No significant trends were found for total cholesterol and HDL-C. Fasting glucose and glycohemoglobin showed significant upward trends (P for trend = 0.001 and 0.027, respectively), with notable increases in Mexican Americans (fasting glucose: 5.90 mmol/L [95% CI: 5.81-6.00] to 6.64 mmol/L [95% CI: 6.26-7.01], P for trend < 0.0001; glycohemoglobin: 5.59% [95% CI: 5.51-5.68] to 6.06% [95% CI: 5.84-6.28], P for trend < 0.001).
CONCLUSIONS AND RELEVANCE Analysis of NHANES data indicates that most cardiovascular and diabetes-related metabolic biomarkers significantly increased from 2013-2014 to 2021-2023, with notable differences across demographic groups. These findings can help shape targeted prevention strategies, especially for addressing the needs of diverse populations.