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The Atherosclerosis Risk in Communities Study

F. Javier Nieto, MD, PhD; Jordi Alonso, MD, PhD; Lloyd E. Chambless, PhD; Ming Zhong, MS; Marion Ceraso, MHS; Fredric J. Romm, MD; Lawton Cooper, MD, MPH; Aaron R. Folsom, MD, MPH; Moyses Szklo, MD, DrPH

Arch Intern Med. 1995;155(7):677-684.

Abstract
Background
A national program for hypertension detection and control was implemented in the 1970s, whereas a similar program for control of hypercholesterolemia has been implemented in recent years. We studied the levels of awareness, treatment, and control of these conditions in US population samples during a 3-year period (1987 to 1989).

Methods
The levels of awareness, treatment (by medication), and adequate control of hypertension (systolic blood pressure, 140 mm Hg; diastolic blood pressure, 90 mm Hg; or antihypertensive medication) and hypercholesterolemia (serum cholesterol level, 6.21 mmol/L [240 mg/dL], or lipid-lowering medication) were studied among participants in the baseline examination of the Atherosclerosis Risk in Communities Study, including 15 739 individuals aged 45 to 64 years.

Results
Eighty-four percent of the hypertensive subjects and 42% of the hypercholesterolemic subjects were aware of their conditions. Overall, 50% of the hypertensive subjects and only 4% of the hypercholesterolemic subjects had their conditions both treated and controlled. Rates of hypertension prevalence, awareness, and control remained stable during the 3-year study period. Hypercholesterolemia prevalence decreased from 30% in 1987 to 25% in 1989; its awareness increased from 31% to 50% during the same period. Hypertensive women were more likely than hypertensive men to be aware and treated, whereas hypercholesterolemia awareness was higher in men than in women. Hypertension awareness was highest in black women, but black hypertensive subjects were less likely than whites to be treated and to have their hypertension controlled. Black hypercholesterolemic subjects were less likely to be either aware or treated.

Conclusions
After the recent implementation of the National Cholesterol Education Program, the levels of awareness, treatment, and control of hypercholesterolemia are improving at a high rate, although they are still substantially lower than those for hypertension. Further improvement is necessary, particularly among certain population groups, such as blacks.

(Arch Intern Med. 1995;155:677-684)

Author Affiliations
From the Department of Epidemiology, The Johns Hopkins University School of Hygiene and Public Health, Baltimore, Md (Drs Nieto and Szklo); Institut Municipal de Investigació Mèdica, Universitat Autònoma de Barcelona (Spain) (Dr Alonso); Department of Biostatistics, University of North Carolina, Chapel Hill (Dr Chambless and Ms Zhong); Maryland Medical Society, Baltimore (Ms Ceraso); Department of Family and Community Medicine, Bowman Gray School of Medicine, Winston-Salem, NC (Dr Romm); National Heart, Lung, and Blood Institute, Bethesda, Md (Dr Cooper); and Department of Epidemiology, University of Minnesota, Minneapolis (Dr Folsom).

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