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., Liu, Yuan, Rao, Michael and Ezzati, Majid (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). pp. 1493-1502. doi:10.1161/CIRCULATIONAHA.113.001470 ISSN 0009-7322.

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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.

Item Type:	Journal Article
Subjects:	Q Science > QP Physiology R Medicine > RA Public aspects of medicine R Medicine > RC Internal medicine
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Mental Health and Wellbeing Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Blood pressure , Cholesterol, Diabetes, Obesity, Cardiovascular system--Diseases , Cardiovascular system--Diseases--Diagnosis , Cardiovascular system--Diseases--Epidemiology
Journal or Publication Title:	Circulation
Publisher:	American Heart Association
ISSN:	0009-7322
Official Date:	9 April 2013
Dates:	Date Event 9 April 2013 Published 12 March 2013 Available
Volume:	127
Number:	14
Page Range:	pp. 1493-1502
DOI:	10.1161/CIRCULATIONAHA.113.001470
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)
RIOXX Funder/Project Grant:	Project/Grant ID RIOXX Funder Name Funder ID UNSPECIFIED Medical Research Council http://dx.doi.org/10.13039/501100000265 UNSPECIFIED National Institute for Health Research http://dx.doi.org/10.13039/501100000272 DK007703 National Institute of Diabetes and Digestive and Kidney Diseases http://dx.doi.org/10.13039/100000062
Open Access Version:	Publisher
Contributors:	Contribution Name Contributor ID Research team member Cappuccio, Francesco 13620

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