The Global Cardiovascular Risk Transition: Associations of Four Metabolic Risk Factors With National Income, Urbanization, and Western Diet in 1980 and 2008

Study Questions:

Are cardiovascular risk factors, including body mass index (BMI), associated with per capita national income, a Western dietary pattern, and percentage of a country’s population residing in urban areas?

Methods:

Country-level risk factor estimates for 199 countries were based on published and unpublished health examination surveys, and population-based epidemiological studies were reviewed to collate comprehensive data on the four major risk factors examined (BMI, systolic blood pressure [SBP], serum total cholesterol [TC], and fasting plasma glucose [FPG]) between 1980 and 2008. There were 960 data sources across countries and years for BMI, 786 for SBP, 321 for TC, and 370 for FPG. National income was measured as per capita gross domestic product (GDP) converted to international dollars and adjusted for inflation with a base year of 2005. The authors used data on the availability of multiple food types for human consumption from the food balance sheets of the Food and Agriculture Organization of the United Nations. The food balance sheets report the availability of 24 food types for human consumption in kilocalories per capita per day. Urbanization was measured as the proportion of a country’s population who live in urban areas by the use of data from the Population Division of the Department of Economic and Social Affairs of the United Nations.

Results:

In 1980, there was a positive association between national income and population mean BMI, SBP, and TC. The relationship between BMI and national income flattened at a per capita GDP of ≈Int$7000. The association between national income and FPG in 1980 was weaker than those of the other three risk factors. By 2008, the slope of the association between national income and SBP became negative for women and zero for men. TC 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. FPG had weaker associations with these country macro-characteristics, but it was positively associated with BMI.

Conclusions:

The investigators concluded that 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 BP in low-income countries, unless effective lifestyle and pharmacological interventions are implemented.

Perspective:

This analysis demonstrates the need for prevention efforts on a global level. Primordial interventions to improve dietary patterns and promote physical activity are the best methods for wide-scale prevention of cardiovascular disease. In order to achieve such interventions, health policy must transcend borders.

Clinical Topics: Dyslipidemia, Prevention, Lipid Metabolism, Nonstatins, Diet

Keywords: Life Style, Hyperglycemia, Pandemics, Income, Blood Pressure, Risk Factors, Urbanization, Glucose, Cholesterol, Body Mass Index, Cardiovascular Diseases, Motor Activity, United Nations, Diabetes Mellitus, Fasting


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