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Cited by 959Obesity, Physical Activity, DietDiabetes, Cardiovascular Risks, and LipoproteinsCardiovascular Health and Risk Factors

Secular Trends in Cardiovascular Disease Risk Factors According to Body Mass Index in US Adults

Gregg, Edward W.·2005·JAMA
DOI 10.1001/jama.293.15.1868
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Abstract

CONTEXT: Prevalence of obesity in the United States has increased dramatically in recent decades, but the magnitude of change in cardiovascular disease (CVD) risk factors among the growing proportion of overweight and obese Americans remains unknown. OBJECTIVE: To examine 40-year trends in CVD risk factors by body mass index (BMI) groups among US adults aged 20 to 74 years. DESIGN, SETTING, AND PARTICIPANTS: Analysis of 5 cross-sectional, nationally representative surveys: National Health Examination Survey (1960-1962); National Health and Nutrition Examination Survey (NHANES) I (1971-1975), II (1976-1980), and III (1988-1994); and NHANES 1999-2000. MAIN OUTCOME MEASURES: Prevalence of high cholesterol level (> or =240 mg/dL [> or =6.2 mmol/L] regardless of treatment), high blood pressure (> or =140/90 mm Hg regardless of treatment), current smoking, and total diabetes (diagnosed and undiagnosed combined) according to BMI group (lean, <25; overweight, 25-29; and obese, > or =30). RESULTS: The prevalence of all risk factors except diabetes decreased over time across all BMI groups, with the greatest reductions observed among overweight and obese groups. Compared with obese persons in 1960-1962, obese persons in 1999-2000 had a 21-percentage-point lower prevalence of high cholesterol level (39% in 1960-1962 vs 18% in 1999-2000), an 18-percentage-point lower prevalence of high blood pressure (from 42% to 24%), and a 12-percentage-point lower smoking prevalence (from 32% to 20%). Survey x BMI group interaction terms indicated that compared with the first survey, the prevalence of high cholesterol in the fifth survey had fallen more in obese and overweight persons than in lean persons (P<.05). Survey x BMI changes in blood pressure and smoking were not statistically significant. Changes in risk factors were accompanied by increases in lipid-lowering and antihypertensive medication use, particularly among obese persons. Total diabetes prevalence was stable within BMI groups over time, as nonsignificant 1- to 2-percentage-point increases occurred between 1976-1980 and 1999-2000. CONCLUSIONS: Except for diabetes, CVD risk factors have declined considerably over the past 40 years in all BMI groups. Although obese persons still have higher risk factor levels than lean persons, the levels of these risk factors are much lower than in previous decades.

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  • In the United States, the prevalence of high cholesterol, hypertension, and smoking, together with age-adjusted cardiovascular deaths, has declined over several decades.

    “In the United States, the prevalence of high cholesterol, hypertension, and smoking, together with age-adjusted cardiovascular deaths, has declined over several decades.35,36”

    From Beyond Established and Novel Risk Factors: Lifestyle Risk Factors for Cardiovascular Disease (2008) · cites this paper as [36]

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Authors
Gregg, E. W.
Affiliations
Centers for Disease Control and Prevention (US)
Corresponding author
Gregg, Edward W.
ORCID
Gregg, Edward W.
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2005-04-20
Volume
293
Issue
15
Pages
1868
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.293.15.1868
OpenAlex
W1994281353
Cited by
959
References
41
Citations by year
2026: 7 · 2025: 4 · 2024: 6 · 2023: 16 · 2022: 14 · 2021: 22 · 2020: 28 · 2019: 33 · 2018: 18 · 2017: 36 · 2016: 39 · 2015: 47 · 2014: 47 · 2013: 56 · 2012: 65
FWCI
100.26
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
Keywords
cardiovascular risk factors, body mass index, obesity, overweight, secular trends, hypercholesterolemia, hypertension, smoking, diabetes prevalence, lipid-lowering drugs, antihypertensive drugs, NHANES, National Health Examination Survey, medication use, United States adults
MeSH terms
Adult, Aged, Antihypertensive Agents, Hypolipidemic Agents, Cardiovascular Diseases, Diabetes Mellitus, Female, Health Surveys, Humans, Hypercholesterolemia, Hypertension, Male, Middle Aged, Obesity, Risk Factors, Smoking, Thinness, United States, Body Mass Index

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