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The global cardiovascular risk transition: associations of four metabolic risk factors with national income, urbanization, and Western diet in 1980 and 2008

The global cardiovascular risk transition: associations of four metabolic risk factors with national income, urbanization, and Western diet in 1980 and 2008
The global cardiovascular risk transition: associations of four metabolic risk factors with national income, urbanization, and Western diet in 1980 and 2008
Background—It is commonly assumed that cardiovascular disease risk factors are associated with affluence and Westernization. We investigated the associations of body mass index (BMI), fasting plasma glucose, systolic blood pressure, and serum total cholesterol with national income, Western diet, and, for BMI, urbanization in 1980 and 2008.

Methods and Results—Country-level risk factor estimates for 199 countries between 1980 and 2008 were from a previous systematic analysis of population-based data. We analyzed the associations between risk factors and per capita national income, a measure of Western diet, and, for BMI, the percentage of the population living in urban areas. In 1980, there was a positive association between national income and population mean BMI, systolic blood pressure, and total cholesterol. By 2008, the slope of the association between national income and systolic blood pressure became negative for women and zero for men. Total cholesterol was associated with national income and Western diet in both 1980 and 2008. In 1980, BMI rose with national income and then flattened at ?Int$7000; by 2008, the relationship resembled an inverted U for women, peaking at middle-income levels. BMI had a positive relationship with the percentage of urban population in both 1980 and 2008. Fasting plasma glucose had weaker associations with these country macro characteristics, but it was positively associated with BMI.

Conclusions—The changing associations of metabolic risk factors with macroeconomic variables indicate that there will be a global pandemic of hyperglycemia and diabetes mellitus, together with high blood pressure in low-income countries, unless effective lifestyle and pharmacological interventions are implemented.

blood pressure, cholesterol, diabetes mellitus, epidemiology, obesity
0009-7322
1493-1502
Danaei, Goodarz
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Singh, Gitanjali M.
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Paciorek, Christopher J.
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Lin, John K.
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Cowan, Melanie J.
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Finucane, Mariel M.
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Farzadfar, Farshad
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Stevens, Gretchen A.
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Riley, Leanne M.
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Lu, Yuan
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Rao, Mayuree
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Ezzati, Majid
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Fall, C.H.
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Danaei, Goodarz
6b9a29bf-f062-4f95-92b6-36818955189b
Singh, Gitanjali M.
85e8f598-66f2-450e-ac33-bd0b3bb2c889
Paciorek, Christopher J.
7f094376-3de4-473d-aa52-dae1618d9a89
Lin, John K.
f5c5e549-2d1f-42e6-bcb8-43d7fe5ce144
Cowan, Melanie J.
576f8235-cc46-4d48-ae51-842e1482e302
Finucane, Mariel M.
c91240a9-88b4-4e75-b42f-bde9dbd53420
Farzadfar, Farshad
a30438b2-ed1e-485d-9949-4fa4bb0a109b
Stevens, Gretchen A.
67365041-92cb-4d25-b006-b415a9da332f
Riley, Leanne M.
be9bb52b-943a-4934-bdb6-5757b6a31b11
Lu, Yuan
bed28890-51c6-4674-bead-6cd1e5497f31
Rao, Mayuree
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Ezzati, Majid
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Fall, C.H.
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Danaei, Goodarz, Singh, Gitanjali M., Paciorek, Christopher J., Lin, John K., Cowan, Melanie J., Finucane, Mariel M., Farzadfar, Farshad, Stevens, Gretchen A., Riley, Leanne M., Lu, Yuan, Rao, Mayuree, Ezzati, Majid and Fall, C.H. (2013) The global cardiovascular risk transition: associations of four metabolic risk factors with national income, urbanization, and Western diet in 1980 and 2008. Circulation, 127 (14), 1493-1502. (doi:10.1161/CIRCULATIONAHA.113.002002). (PMID:23481623)

Record type: Article

Abstract

Background—It is commonly assumed that cardiovascular disease risk factors are associated with affluence and Westernization. We investigated the associations of body mass index (BMI), fasting plasma glucose, systolic blood pressure, and serum total cholesterol with national income, Western diet, and, for BMI, urbanization in 1980 and 2008.

Methods and Results—Country-level risk factor estimates for 199 countries between 1980 and 2008 were from a previous systematic analysis of population-based data. We analyzed the associations between risk factors and per capita national income, a measure of Western diet, and, for BMI, the percentage of the population living in urban areas. In 1980, there was a positive association between national income and population mean BMI, systolic blood pressure, and total cholesterol. By 2008, the slope of the association between national income and systolic blood pressure became negative for women and zero for men. Total cholesterol was associated with national income and Western diet in both 1980 and 2008. In 1980, BMI rose with national income and then flattened at ?Int$7000; by 2008, the relationship resembled an inverted U for women, peaking at middle-income levels. BMI had a positive relationship with the percentage of urban population in both 1980 and 2008. Fasting plasma glucose had weaker associations with these country macro characteristics, but it was positively associated with BMI.

Conclusions—The changing associations of metabolic risk factors with macroeconomic variables indicate that there will be a global pandemic of hyperglycemia and diabetes mellitus, together with high blood pressure in low-income countries, unless effective lifestyle and pharmacological interventions are implemented.

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Published date: 9 April 2013
Keywords: blood pressure, cholesterol, diabetes mellitus, epidemiology, obesity
Organisations: Human Development & Health

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Local EPrints ID: 355134
URI: http://eprints.soton.ac.uk/id/eprint/355134
ISSN: 0009-7322
PURE UUID: 43e2cff1-e30c-4abc-9e05-613c8b997853
ORCID for C.H. Fall: ORCID iD orcid.org/0000-0003-4402-5552

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Date deposited: 13 Aug 2013 09:27
Last modified: 28 Oct 2023 01:34

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Contributors

Author: Goodarz Danaei
Author: Gitanjali M. Singh
Author: Christopher J. Paciorek
Author: John K. Lin
Author: Melanie J. Cowan
Author: Mariel M. Finucane
Author: Farshad Farzadfar
Author: Gretchen A. Stevens
Author: Leanne M. Riley
Author: Yuan Lu
Author: Mayuree Rao
Author: Majid Ezzati
Author: C.H. Fall ORCID iD

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