Obesity effects on glucose, blood pressure are offsetting gains in smoking status, cholesterol

Orlando, FL - Despite improvements in lowering cholesterol and smoking status over the past 20 years, overall risk-factor profiles in American adults today are identical to those of men and women in the US two decades ago. This apparent plateau is likely explained by the ever-worsening obesity epidemic, Dr Kamakki Banks (UT Southwestern, Dallas, TX) reported last week at the American Heart Association 2009 Scientific Sessions.

“There has been no change in the distribution of risk-factor profiles over 20 years,” Banks explained to heartwire. “What I mean by that is that we have the same proportion of people who have an optimal risk-factor profile, the same proportion who are borderline high risk, and the same proportion of people who are elevated. . . . It’s disheartening. For those of us who work in this field, we were expecting to see that after 20 years of intense public-health intervention we would have less elevated people and more optimal people. But we didn’t see that.”

Using data from the National Health and Nutrition Examination Survey (NHANES) collected between 1988 and 1994 (NHANES III) and in 2005 and 2006 (the most recent data available), Banks et al looked at blood pressure, fasting glucose, LDL cholesterol, and smoking status to stratify study subjects (age, 20-75) as having optimal, borderline, or elevated risk factors. To their surprise, the percentage of subjects in each category stayed almost completely static.

Changes in risk-factor profiles

To understand the lack of improvement, Banks et al then looked at whether there were “offsetting” changes within individual risk factors. They found that the number of subjects in the optimal category for smoking and LDL increased over the study period, whereas the number of borderline patients decreased (the elevated group remained unchanged). For glucose levels and blood pressure, the patterns were reversed; numbers of optimal subjects declined and the numbers of borderline and elevated subjects increased in both groups. As Banks reminded heartwire, glucose levels and blood pressure are both closely related to obesity; over the same time period, average BMI increased from 26.6 to 28.7 kg/m², she noted.

Obesity is hindering our success at reducing CV risk.

“We went into this thinking we would see a positive change,” Banks said. Instead, “there was a total balancing of risk over the two time periods. . . . We believe, if it were not for the effects of obesity, we may have been able to see some improvements in the CV risk-factor profiles over the last 20 years,” Banks said. “The message here is that obesity is hindering our success at reducing CV risk.”

Of note, this study looked only at risk-factor profiles in adults; Banks predicts that risk-factor profiles in the future will be even worse, given rates of childhood obesity.

“As physicians, we’re very good at treating things when they are elevated, but we have to change our mindset, our focus, to prevention and consider it as important as treatment,” she said. “Otherwise, this is going to reverse all the good work that we’re doing. Right now we’re seeing a balancing [of risk-factor changes], but if the obesity epidemic continues, we’re going to see cardiovascular morbidity and mortality increasing.”

November 23, 2009, Shelley Wood
Theheart

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