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South Med J. Author manuscript; available in PMC 2017 June 01. Published in final edited form as: South Med J. 2016 June ; 109(6): 346–350. doi:10.14423/SMJ.0000000000000473.
Cardiovascular Health Status in Baby Boomers with Diabetes Mellitus Dana E. King, MD, MS, Jun Xiang, MS, and Ambar Kulshreshtha, MD, PhD Department of Family Medicine West Virginia University School of Medicine, Robert C. Byrd Health Sciences Center, Morgantown, and the Department of Family and Preventive Medicine, Emory University, Atlanta, Georgia
Author Manuscript
Abstract Objectives—The objective of this study was to assess the cardiovascular health status of baby boomers with diabetes mellitus (DM) in comparison to the same-age population with DM 10 years previously. Methods—The study was conducted in baby boomers with DM using data from the National Health and Nutrition Examination Survey (NHANES) 2009–2012 compared with NHANES 1999–2002. Cardiovascular health metrics were derived from the American Heart Association’s Life’s Simple 7. The primary outcome was the comparison of the proportion of individuals with each characteristic, including healthy diet, healthy weight, not smoking, exercising regularly, and maintaining an optimal level of glycated hemoglobin (HbA1c), cholesterol, and blood pressure.
Author Manuscript
Results—Current baby boomers with DM (NHANES 2009–2012) had more obesity (70.9% vs 58.8%; P = 0.009) and a lower proportion of ideal physical activity (20.9% vs 31.7%; P = 0.01) than people of the same age 10 years ago; fewer than 1% adhere to an ideal healthy diet. Current baby boomers more often had ideal cholesterol (59.4% vs 47.2; P = 0.01) and reached an ideal HbA1c (51.0% vs 43.4%; P = 0.047). Blood pressure control, adherence to ideal diet, and smoking rates were not significantly different from 10 years ago. In logistic regression analyses controlling for likely confounders, baby boomers persisted in having more obesity and exercising less often, and reaching an ideal cholesterol level more often (P < 0.01). Conclusions—Although improving in cholesterol and HbA1c, baby boomers demonstrated worsening in several key cardiovascular health indicators, particularly obesity and physical activity.
Author Manuscript
Keywords cardiovascular; diet; exercise; obesity; hypertension
Correspondence to Dr Dana E King, Department of Family Medicine, West Virginia University School of Medicine, Box 9152, Robert C. Byrd Health Sciences Center, Morgantown, WV 26506. ; Email: [email protected] To purchase a single copy of this article, visit http://sma.org/smj-home. To purchase larger reprint quantities, please contact [email protected] The study was presented at the meeting of the North American Primary Care Research Group in New York, NY, November 23, 2014. D.E.K. has received compensation or has had relationships with the following entities: Alcon Foundation, Allergan, Centers for Medicare & Medicaid Services, Health Resources and Services Administration, Oxford University Press, and Pfizer. The remaining authors have no financial relationships to disclose and no conflicts of interest to report.
King et al.
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Author Manuscript
The 76.4 million baby boomers (individuals born in the United States between 1946 and 1 1964) represent close to one-fourth of the US population and are major contributors to the diabetes mellitus (DM) epidemic. It is projected that one in every four baby boomers soon 23 will be living with this chronic disease. , DM complications, disability, and the need for 4 7 continuous management will put a greater demand on the healthcare system. – The lifestyle habits of the baby boomer generation with DM are critical to their overall health and their cardiovascular risk. The baby boomers’ adherence to healthy lifestyle habits is likely to have profound implications on the health of the nation in the next few years because of the 478 enormous size of the population cohort. , ,
Author Manuscript
The health status of the baby boomer generation has been examined in studies, with mixed 9 10 results. , Some studies have demonstrated lower rates of smoking and fewer heart attacks among baby boomers compared with previous generations, whereas others showed increased 4 9 11 rates of DM and obesity. , –
Author Manuscript
Based on evidence from randomized clinical trials and epidemiologic studies, the American Heart Association (AHA) identified seven ideal cardiovascular health metrics (“Life’s 12 Simple 7”) to monitor health factors and behaviors at population levels. These factors are a key component of management of patients with DM. More information is needed regarding the adherence to healthy lifestyle habits and cardiovascular health characteristics of baby boomers with DM to assist public health policy makers in their efforts to address the 13 nation’s health issues. As such, the goal of the present study was to compare the cardiovascular health characteristics of baby boomers with DM in the National Health and Nutrition Examination Survey (NHANES) 2009–2012 with the cardiovascular health characteristics from a same-age group of adults from 10 years previously in the NHANES 1999–2002.
Methods Study Population
Author Manuscript
The NHANES is a series of complex and multistage surveys aiming to assess the health and nutritional status of the noninstitutionalized population of the United States. Detailed descriptions of the plan and operation of each survey have been published and NHANES received approval from the National Center for Health Statistics Research Ethics Review 14 Board. To compare the difference in ideal cardiovascular health characteristics between baby boomers with DM and a similar population 10 years ago, we selected 46- to 64-yearold respondents from two cohorts, NHANES 1999–2002 and NHANES 2009–2012 (baby 14 boomers), who responded positively to “told by a doctor that you have diabetes.” Definition of Cardiovascular Health Metrics Life’s Simple 7, developed by the AHA as part of their 2020 goals, consists of seven key health factors and behaviors listed as blood pressure, physical activity, cholesterol, healthy diet, healthy weight, smoking status, and blood glucose. The metrics were chosen because of the important role they play in cardiovascular risk among all adults, especially baby 10 13 boomers. – The AHA definition of cardiovascular health metrics was modified according
South Med J. Author manuscript; available in PMC 2017 June 01.
King et al.
Page 3
Author Manuscript
to our unique sample population and limitation of the information in the NHANES. The modified definition of ideal, intermediate, and poor cardiovascular health for each of the seven components for this study is presented in Table 1. The AHA definition of cardiovascular health metrics includes the criteria of treatment to goal for two health factors: blood pressure and cholesterol. We used all of the available measurements for these two factors of the AHA’s metrics to determine whether a subject was in ideal, intermediate, or poor cardiovascular health for each factor.
Author Manuscript
Because the population studied currently had DM, rather than being at risk for DM, we used glycated hemoglobin (HbA1C) to evaluate subjects’ blood glucose level instead of fasting serum glucose used in the AHA definition. HbA1C values of 9% were classified into ideal, intermediate, and poor categories of cardiovascular health metrics for blood glucose.
Author Manuscript
To locate information we could use to identify healthy diet components, we applied the Food Patterns Equivalents Database created by the US Department of Agriculture to designated 15 NHANES cycles. Because no information regarding sugar-sweetened beverage intake was found in the two NHANES cohorts we selected, we replaced it with the added-sugar intake based on the daily intake recommendation from the AHA. Intake per day for fruits and vegetables, whole grains, sodium, added sugar, and number of times per week for all kinds of fish were calculated first, and then 1 point each was assigned to subjects who had goal consumption of fruits and vegetables (≥4.5 cups/day), whole grains (≥3 oz/day), sodium (
South Med J. Author manuscript; available in PMC 2017 June 01. Published in final edited form as: South Med J. 2016 June ; 109(6): 346–350. doi:10.14423/SMJ.0000000000000473.
Cardiovascular Health Status in Baby Boomers with Diabetes Mellitus Dana E. King, MD, MS, Jun Xiang, MS, and Ambar Kulshreshtha, MD, PhD Department of Family Medicine West Virginia University School of Medicine, Robert C. Byrd Health Sciences Center, Morgantown, and the Department of Family and Preventive Medicine, Emory University, Atlanta, Georgia
Author Manuscript
Abstract Objectives—The objective of this study was to assess the cardiovascular health status of baby boomers with diabetes mellitus (DM) in comparison to the same-age population with DM 10 years previously. Methods—The study was conducted in baby boomers with DM using data from the National Health and Nutrition Examination Survey (NHANES) 2009–2012 compared with NHANES 1999–2002. Cardiovascular health metrics were derived from the American Heart Association’s Life’s Simple 7. The primary outcome was the comparison of the proportion of individuals with each characteristic, including healthy diet, healthy weight, not smoking, exercising regularly, and maintaining an optimal level of glycated hemoglobin (HbA1c), cholesterol, and blood pressure.
Author Manuscript
Results—Current baby boomers with DM (NHANES 2009–2012) had more obesity (70.9% vs 58.8%; P = 0.009) and a lower proportion of ideal physical activity (20.9% vs 31.7%; P = 0.01) than people of the same age 10 years ago; fewer than 1% adhere to an ideal healthy diet. Current baby boomers more often had ideal cholesterol (59.4% vs 47.2; P = 0.01) and reached an ideal HbA1c (51.0% vs 43.4%; P = 0.047). Blood pressure control, adherence to ideal diet, and smoking rates were not significantly different from 10 years ago. In logistic regression analyses controlling for likely confounders, baby boomers persisted in having more obesity and exercising less often, and reaching an ideal cholesterol level more often (P < 0.01). Conclusions—Although improving in cholesterol and HbA1c, baby boomers demonstrated worsening in several key cardiovascular health indicators, particularly obesity and physical activity.
Author Manuscript
Keywords cardiovascular; diet; exercise; obesity; hypertension
Correspondence to Dr Dana E King, Department of Family Medicine, West Virginia University School of Medicine, Box 9152, Robert C. Byrd Health Sciences Center, Morgantown, WV 26506. ; Email: [email protected] To purchase a single copy of this article, visit http://sma.org/smj-home. To purchase larger reprint quantities, please contact [email protected] The study was presented at the meeting of the North American Primary Care Research Group in New York, NY, November 23, 2014. D.E.K. has received compensation or has had relationships with the following entities: Alcon Foundation, Allergan, Centers for Medicare & Medicaid Services, Health Resources and Services Administration, Oxford University Press, and Pfizer. The remaining authors have no financial relationships to disclose and no conflicts of interest to report.
King et al.
Page 2
Author Manuscript
The 76.4 million baby boomers (individuals born in the United States between 1946 and 1 1964) represent close to one-fourth of the US population and are major contributors to the diabetes mellitus (DM) epidemic. It is projected that one in every four baby boomers soon 23 will be living with this chronic disease. , DM complications, disability, and the need for 4 7 continuous management will put a greater demand on the healthcare system. – The lifestyle habits of the baby boomer generation with DM are critical to their overall health and their cardiovascular risk. The baby boomers’ adherence to healthy lifestyle habits is likely to have profound implications on the health of the nation in the next few years because of the 478 enormous size of the population cohort. , ,
Author Manuscript
The health status of the baby boomer generation has been examined in studies, with mixed 9 10 results. , Some studies have demonstrated lower rates of smoking and fewer heart attacks among baby boomers compared with previous generations, whereas others showed increased 4 9 11 rates of DM and obesity. , –
Author Manuscript
Based on evidence from randomized clinical trials and epidemiologic studies, the American Heart Association (AHA) identified seven ideal cardiovascular health metrics (“Life’s 12 Simple 7”) to monitor health factors and behaviors at population levels. These factors are a key component of management of patients with DM. More information is needed regarding the adherence to healthy lifestyle habits and cardiovascular health characteristics of baby boomers with DM to assist public health policy makers in their efforts to address the 13 nation’s health issues. As such, the goal of the present study was to compare the cardiovascular health characteristics of baby boomers with DM in the National Health and Nutrition Examination Survey (NHANES) 2009–2012 with the cardiovascular health characteristics from a same-age group of adults from 10 years previously in the NHANES 1999–2002.
Methods Study Population
Author Manuscript
The NHANES is a series of complex and multistage surveys aiming to assess the health and nutritional status of the noninstitutionalized population of the United States. Detailed descriptions of the plan and operation of each survey have been published and NHANES received approval from the National Center for Health Statistics Research Ethics Review 14 Board. To compare the difference in ideal cardiovascular health characteristics between baby boomers with DM and a similar population 10 years ago, we selected 46- to 64-yearold respondents from two cohorts, NHANES 1999–2002 and NHANES 2009–2012 (baby 14 boomers), who responded positively to “told by a doctor that you have diabetes.” Definition of Cardiovascular Health Metrics Life’s Simple 7, developed by the AHA as part of their 2020 goals, consists of seven key health factors and behaviors listed as blood pressure, physical activity, cholesterol, healthy diet, healthy weight, smoking status, and blood glucose. The metrics were chosen because of the important role they play in cardiovascular risk among all adults, especially baby 10 13 boomers. – The AHA definition of cardiovascular health metrics was modified according
South Med J. Author manuscript; available in PMC 2017 June 01.
King et al.
Page 3
Author Manuscript
to our unique sample population and limitation of the information in the NHANES. The modified definition of ideal, intermediate, and poor cardiovascular health for each of the seven components for this study is presented in Table 1. The AHA definition of cardiovascular health metrics includes the criteria of treatment to goal for two health factors: blood pressure and cholesterol. We used all of the available measurements for these two factors of the AHA’s metrics to determine whether a subject was in ideal, intermediate, or poor cardiovascular health for each factor.
Author Manuscript
Because the population studied currently had DM, rather than being at risk for DM, we used glycated hemoglobin (HbA1C) to evaluate subjects’ blood glucose level instead of fasting serum glucose used in the AHA definition. HbA1C values of 9% were classified into ideal, intermediate, and poor categories of cardiovascular health metrics for blood glucose.
Author Manuscript
To locate information we could use to identify healthy diet components, we applied the Food Patterns Equivalents Database created by the US Department of Agriculture to designated 15 NHANES cycles. Because no information regarding sugar-sweetened beverage intake was found in the two NHANES cohorts we selected, we replaced it with the added-sugar intake based on the daily intake recommendation from the AHA. Intake per day for fruits and vegetables, whole grains, sodium, added sugar, and number of times per week for all kinds of fish were calculated first, and then 1 point each was assigned to subjects who had goal consumption of fruits and vegetables (≥4.5 cups/day), whole grains (≥3 oz/day), sodium (
