Geographic Variation in Cardiovascular Health Among American Adults

Vibhu Parcha, Rajat Kalra, Sarabjeet S. Suri, Gargya Malla, Thomas J. Wang, Garima Arora, Pankaj Arora

Research output: Contribution to journalArticlepeer-review

28 Scopus citations


OBJECTIVE: To evaluate the contemporary geographic trends in cardiovascular health in the United States and its relationship with geographic distribution of cardiovascular mortality.

METHODS: By use of a retrospective cross-sectional design, the 2011-2017 Behavioral Risk Factor Surveillance System (BRFSS) was queried to determine the age-adjusted prevalence of cardiovascular health index (CVHI) metrics (sum of ideal blood pressure, blood glucose concentration, lipid levels, body mass index, smoking, physical activity, and diet). Cardiovascular health was estimated as both continuous (0 to 7 points) and categorical (ideal, intermediate, poor) variables from the BRFSS. Age-adjusted cardiovascular mortality for 2017 was obtained from the Centers for Disease Control and Prevention WONDER database.

RESULTS: Among 1,362,529 American adult participants of the BRFSS 2011-2017 and all American residents in 2017, the CVHI score increased from 3.89±0.004 in 2011 to 3.96±0.005 in 2017 (P trend<.001) nationally, with modest improvement across all regions (P trend<.05 for all). Ideal cardiovascular health prevalence improved in the northeastern (P trend=.03) and southern regions (P trend=.002). In 2017, the prevalence of coronary heart disease (6.8%; 95% CI, 6.5% to 7.1%) and stroke (3.7%; 95% CI, 3.4% to 3.9%) was highest in the southern region. The CVHI score (3.81±0.01) and the prevalence of ideal cardiovascular health (12.2%; 95% CI, 11.7% to 12.7%) were lowest in the southern United States. This corresponded to the higher cardiovascular mortality in the southern region (233.0 [95% CI, 232.2- to 33.8] per 100,000 persons).

CONCLUSION: Despite a modest improvement in CVHI, only 1 in 6 Americans has ideal cardiovascular health with significant geographic differences. These differences correlate with the geographic distribution of cardiovascular mortality. An urgent unmet need exists to mitigate the geographic disparities in cardiovascular morbidity and mortality.

Original languageEnglish (US)
Pages (from-to)1770-1781
Number of pages12
JournalMayo Clinic Proceedings
Issue number7
Early online dateMar 25 2021
StatePublished - Jul 2021

Bibliographical note

Publisher Copyright:
© 2021 Mayo Foundation for Medical Education and Research


  • Behavioral Risk Factor Surveillance System
  • Blood Glucose/analysis
  • Blood Pressure/physiology
  • Body Mass Index
  • Cardiovascular Diseases/diagnosis
  • Cardiovascular System/metabolism
  • Cross-Sectional Studies
  • Diet/psychology
  • Exercise/physiology
  • Female
  • Geography
  • Health Status
  • Humans
  • Male
  • Middle Aged
  • Mortality
  • Prevalence
  • Risk Factors
  • Smoking/epidemiology
  • United States/epidemiology

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural


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