Across 11 NHANES cycles and 60,199 US adults, obesity rose from 47.4% to 57.2%, with class III obesity more than doubling (4.7% to 9.7%). Diabetes climbed from 8.2% to 12.7% while smoking fell from 24.4% to 14.9%. Mean systolic pressure and total cholesterol dropped, and LDL control doubled to 34.2%. But blood pressure control peaked at 32.5% in 2013-2014 and fell to 21.5%; glycemic control slid from 51.2% to 41.9%. PREVENT-predicted 10-year ASCVD risk declined while heart failure risk rose, converging at about 3.2% each.
The divergence between falling atherosclerotic risk and rising heart failure risk is the most instructive result. Smoking cessation and lipid lowering have blunted coronary and stroke risk, but obesity and diabetes drive heart failure, which those tools barely touch. That fits the broader literature on obesity-related HFpEF and suggests ASCVD gains may not translate into fewer cardiac events for long. The post-2014 slide in blood pressure control echoes earlier NHANES analyses and remains poorly explained; candidate causes include access disruptions, therapeutic inertia, and the pandemic. For readers, the practical message is to know your own numbers: confirm that blood pressure and HbA1c are actually at target, not merely treated, and treat weight as a cardiovascular risk factor alongside cholesterol. Caveats matter: NHANES is cross-sectional, PREVENT estimates are modeled rather than observed events, and measurement protocols changed over 24 years. This is a preprint awaiting peer review, so figures may shift. The findings are largely confirmatory of known trends, but the side-by-side ASCVD and heart failure projections add useful nuance.