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Gregg EW, Cheng YJ, Cadwell BL, et al. Secular Trends in Cardiovascular Disease Risk Factors According to
Body Mass Index in US Adults. JAMA. 2005;293(15):1868–1874. doi:10.1001/jama.293.15.1868
Author Affiliations: Division of Diabetes Translation,
National Center for Chronic Disease Prevention and Health Promotion, Centers
for Disease Control and Prevention, Atlanta, Ga (Drs Gregg, Cheng, Imperatore,
Williams, Narayan, and Williamson and Ms Cadwell); National Center for Health
Statistics, Centers for Disease Control and Prevention, Hyattsville, Md (Dr
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
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
Main Outcome Measures Prevalence of high cholesterol level (≥240 mg/dL [≥6.2 mmol/L]
regardless of treatment), high blood pressure (≥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,
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 × 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 × 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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