title: The global cardiovascular risk transition: associations of four metabolic risk factors with national income, urbanization, and Western diet in 1980 and 2008.
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.
  
  
  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.
authors.affiliation: Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Goodarz
authors.initials: G
authors.lastname: Danaei
authors.forename: Gitanjali M
authors.initials: GM
authors.lastname: Singh
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Paciorek
authors.forename: John K
authors.initials: JK
authors.lastname: Lin
authors.forename: Melanie J
authors.initials: MJ
authors.lastname: Cowan
authors.forename: Mariel M
authors.initials: MM
authors.lastname: Finucane
authors.forename: Farshad
authors.initials: F
authors.lastname: Farzadfar
authors.forename: Gretchen A
authors.initials: GA
authors.lastname: Stevens
authors.forename: Leanne M
authors.initials: LM
authors.lastname: Riley
authors.forename: Yuan
authors.initials: Y
authors.lastname: Lu
authors.forename: Mayuree
authors.initials: M
authors.lastname: Rao
authors.forename: Majid
authors.initials: M
authors.lastname: Ezzati
mesh_terms: D000328:Adult; D017677:Age Distribution; D001794:Blood Pressure; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000191:economics / Q000453:epidemiology*; D002784:Cholesterol / Q000097:blood; D003906:Developing Countries / Q000191:economics / Q000706:statistics & numerical data; D003920:Diabetes Mellitus / Q000191:economics / Q000453:epidemiology*; D005247:Feeding Behavior; D005260:Female; D014943:Global Health; D006801:Humans; D006937:Hypercholesterolemia / Q000191:economics / Q000453:epidemiology*; D006973:Hypertension / Q000191:economics / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D017678:Sex Distribution; D012959:Socioeconomic Factors; D014507:Urbanization; D019366:Western World
chemical_list: D002784:Cholesterol