Secular Trends in Cardiovascular Disease Risk Factors According to Body Mass Index in US Adults

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 (> or =240 mg/dL [> or =6.2 mmol/L] regardless of treatment), high blood pressure (> or =140/90 mm Hg regardless of treatment), current smoking, and total diabetes (diagnosed and undiagnosed combined) according to BMI group (lean, or =30).

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