Trends in unawareness of cardiovascular disease risk factors among racial & ethnic groups in the United States

Cardiovascular disease remains a leading cause of morbidity and mortality in the United States [1].Timely identification and management of risk factors such as hypertension, hyperlipidemia, and diabetes are critical to improving outcomes [1].Recent data suggest rising hypertension unawareness, particularly among younger adults and women [2].However, racial disparities in awareness of these risk factors remain poorly characterized.We aimed to examine temporal trends in awareness among non-Hispanic Black, non-Hispanic White, and Hispanic adults using nationally representative data.We analyzed data from the National Health and Nutrition Examination Survey (NHANES), a nationally representative survey that combines interviews, physical examinations, and laboratory testing to assess health status in the U.S. population.This study did not require ethical board approval given the use of publicly available, anonymous data, in accordance with the Common Rule.Adults aged ≥18 years with at least one cardiovascular risk factor, hypertension, hyperlipidemia, or diabetes, were included.Diabetes was defined as fasting glucose ≥126 mg/dL or hemoglobin A1c ≥6.5 %; hypertension as systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg (averaged over three readings), or antihypertensive use; and hyperlipidemia as total cholesterol ≥240 mg/dL [3].Participants were considered "unaware" if they met objective criteria but reported never being told they had the condition by a healthcare professional on survey questionnaires.We applied a uniform definition of hypertension across all NHANES cycles.Although guideline thresholds were lowered in 2017, we intentionally did not adopt the newer criteria in later cycles, as doing so would have introduced artificial shifts in prevalence and