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Edward W. Gregg, PhD; Yiling J. Cheng, MD, PhD; Betsy L. Cadwell, MSPH; Giuseppina Imperatore, MD, PhD; Desmond E. Williams, MD, PhD; Katherine M. Flegal, PhD; K. M. Venkat Narayan, MD; David F. Williamson, PhD

JAMA. 2005;293:1868-1874.

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 (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, 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.

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 Flegal).

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