Ideal Cardiovascular Health Among American Adults After the Economic Recession of 2008–2009: Insights from the National Health and Nutrition Examination Survey

Abstract Background The economic recession of 2008–2009 resulted in unprecedented employment and economic losses leading to deterioration of cardiovascular health. We examined the trends in ideal cardiovascular health as measured by the AHA's Life's Simple 7 metric during the periods of economic-recession and subsequent economic-recovery. Methods Data on adults aged ≥ 20 years from the NHANES from economic-recession (2007–2010) and post-recession (2011–2016) periods was analyzed. The AHA's Life's Simple 7 score of 10–14 was utilized to classify ideal cardiovascular health status. Socioeconomic status was divided into three categories: high, middle, and low based on education and income status. Multivariable linear and logistic regression models including demographics, insurance status, healthcare access, and adjustment for multiple testing were used to analyze the trends in prevalence of ideal cardiovascular health across socioeconomic strata. Results We observed a decline in the multivariable-adjusted mean cardiovascular health score from 8.18 in 2007–2010 to 7.94 in 2015–2016 (P linear  = 0.02). This was primarily driven by the increasing prevalence of obesity (34% in 2007–2010 vs. 41% in 2015–2016, P linear  = 0.005) and poor fasting glucose (8% in 2007–2010 vs. 12% in 2015–2016, P linear  = 0.003). In multivariable-adjusted models, we observed the decreasing prevalence of ideal cardiovascular health with a non-linear trend in the participants in the highest (51% in 2007–2010 vs. 42% in 2015–2016, P quadratic  = 0.01) and lowest socioeconomic strata (16% in 2007–2010 vs. 13% in 2015–2016, P quadratic  = 0.02). The prevalence of ideal cardiovascular health was higher in participants with high-socioeconomic status compared with other socioeconomic status participants. Conclusions Despite economic recovery, ideal cardiovascular health metrics have not yet recovered. Cardiovascular health appears to be further deteriorating for American adults, particularly those in high-and lower-socioeconomic strata.