Table 2.
Medication Use in Adult NHANES Participants With ASCVD, 1999 to 2002 to 2015 to 2018, Weighted
| Treatment | Adults with ASCVD, % (95% CI)* | P joinpoint † | P trend ‡ | ||||
|---|---|---|---|---|---|---|---|
| 1999–2002 (n=1096) | 2003–2006 (n=1129) | 2007–2010 (n=1246) | 2011–2014 (n=1049) | 2015–2018 (n=1197) | |||
| ≥1 Lipid‐lowering agents | 41.8 (37.6–46.2) | 49.7 (45.6–53.9) | 58.6 (55.1–62.1) | 66.7 (62.4–70.8) | 63.3 (58.3–68.1) | 0.005 | <0.001 |
| Statin | 38.8 (34.6–43.2) | 45.5 (41.3– 49.8) | 54.5 (51.2–57.7) | 64.2 (60.1–68.1) | 61.1 (56.0–65.9) | 0.01 | <0.001 |
| Ezetimibe | 5.0 (2.9–8.4) | 9.4 (7.3–11.9) | 4.3 (2.8–6.5) | 2.5 (1.6–4.1) | |||
| ≥1 Antihypertensive agents | 74.2 (69.9–78.2) | 76 (71.1–80.2) | 77.3 (74.5–79.9) | 78.4 (74.6–81.7) | 78.8 (75.7–81.7) | 0.38 | 0.06 |
| ACEI/ARB | 34.2 (30.1–38.5) | 45 (41.4–48.7) | 50.4 (47.5–53.3) | 51.6 (47.3–55.8) | 50.5 (46.4–54.5) | 0.003 | <0.001 |
| β‐Blocker | 33.3 (29.2–37.7) | 45.2 (40.8–49.7) | 49.8 (46.5–53) | 46.9 (43.1–50.7) | 51.8 (47.6–55.9) | 0.05 | <0 0.001 |
| CCB | 28.1 (24.3–32.2) | 25 (21.9–28.4) | 23 (20.4–25.7) | 23.4 (20.4–26.7) | 20.4 (16.8–24.6) | 0.66 | 0.006 |
| Diuretics | 32.1 (27.9–36.5) | 37.2 (33.1–41.5) | 36.8 (33.3–40.5) | 30.5 (26.5–34.9) | 28.7 (24.7–33.2) | 0.002 | 0.02 |
| ≥1 Antihypertensive agents in those with self‐reported hypertension | 87.0 (83.5–89.8) | 88.0 (84.0–91.2) | 88.4 (84.7–91.3) | 89.3 (85.9–92.0) | 89.8 (86.4–92.5) | 0.57 | 0.23 |
| ≥1 Antidiabetic agents | 16.0 (13.4–19.1) | 20.1 (16.8–23.7) | 24.8 (22–27.9) | 27.1 (23.2–31.3) | 29.5 (26.7–32.5) | 0.23 | <0.001 |
| Insulin | 4.4 (2.9–6.8) | 5.7 (4–8) | 7.3 (5.6–9.4) | 10.2 (8.2–12.7) | 9.6 (7.9–11.6) | 0.20 | <0.001 |
| Metformin | 5.6 (4.3–7.2) | 10.1 (8–12.6) | 13.4 (11.3–15.8) | 15.4 (12.6–18.6) | 18.9 (16.1–22.1) | 0.13 | <0 0.001 |
| Sulfonylureas | 8.8 (7.3–10.6) | 10.1 (8.1–12.5) | 12.6 (10.8–14.7) | 10.4 (8–13.5) | 9.6 (7.9–11.5) | 0.27 | 0.68 |
| Dipeptidyl peptidase 4 inhibitor | 1.6 (0.8–3) | 3.6 (2.4–5.3) | 4.3 (2.9–6.2) | ||||
| Thiazolidinedione | 1.9 (1.1–3.2) | 6.5 (5.1–8.3) | 5.1 (3.5–7.2) | 1.8 (0.9–3.6) | 1.5 (0.6–3.3) | 0.005 | 0.002 |
| SGLT2 inhibitor or GLP‐1 | 0.2 (0–1.2) | 0.03 (0.004–0.2) | 1.1 (0.5–2.1) | 3.1 (1.9–5.1) | |||
| ≥1 Antidiabetic agents in those with self‐reported diabetes | 74.5 (66.5–81.2) | 75.0 (66.4–82.0) | 86.0 (81.4–89.5) | 85.3 (79.5–89.7) | 80.7 (73.9–86.1) | 0.004 | <0.001 |
| Aspirin among those aged ≥40 y§ | 63.5 (59.4–67.5) | 65.5 (60.5–70.3) | |||||
| Clopidogrel | 4.2 (3.3–5.4) | 14.9 (11.9–18.5) | 17 (14.2–20.4) | 16.9 (13.9–20.4) | 17.5 (14.3–21.2) | <0.001 | <0.001 |
| Prasugrel | 0.2 (0.0–1.5) | 1.4 (0.5–3.6) | 0.4 (0.1–1.4) | ||||
ACEI indicates angiotensin‐converting enzyme inhibitor; ARB, angiotensin receptor blocker; ASCVD, atherosclerotic cardiovascular disease; CCB, calcium channel blocker; GLP‐1, glucagon‐like peptide‐1; NHANES, National Health and Nutrition Examination Survey; and SGLT2, sodium‐dependent glucose transporter 2.
NHANES weights were adjusted to generate nationally representative percentages.
Joinpoint regression was used to identify whether 1 joinpoint occurred, and statistical significance of the joinpoint was tested using the Monte Carlo permutation method.
The overall trend of risk factor control from 1999 to 2018 was analyzed using logistics regression modeling the survey cycle as a continuous variable.
The aspirin data were presented from 2011 to 2012, because low‐dose aspirin is usually an over‐the‐counter medication in the United States and prescription aspirin use collected in the prescription medication data files before the 2011 to 2012 cycle was mainly to assess aspirin therapy in arthritis and musculoskeletal use or to assess general analgesic use prevalence.