Trends in cardiovascular disease risk factors by BMI category among adults in England, 2003-2018

This study aimed to estimate trends in cardiovascular disease risk factors by BMI category among adults in England (n = 115,860).

Risk factors included cigarette smoking, hypertension, total diabetes, and raised total cholesterol. Risk factor prevalence was computed in the following four 4-year time periods: 2003-2006; 2007-2010; 2011-2014; and 2015-2018. Change was computed as the difference between the first and last time periods, expressed in percentage points (PP).

Hypertension remained at a stable level among men with normal weight but decreased among men with obesity (-4.1 PP; 95% CI: -7.1 to -1.0). Total diabetes remained at a stable level among adults with normal weight but increased among adults with obesity (men: 3.5 PP, 95% CI: 1.2 to 5.7; women: 3.6 PP, 95% CI: 1.8 to 5.4). Raised total cholesterol decreased in all BMI groups but fell more sharply among women with obesity (-21 PP; 95% CI: -25 to -17) versus their counterparts with normal weight (-16 PP; 95% CI: -18 to -14).

Greater reductions in hypertension and raised total cholesterol among adults with overweight and obesity partially reflect improvements in screening, treatment, and control among those at highest cardiovascular risk. Higher levels of risk factor prevalence among adults with overweight and obesity, in parallel with rising diabetes, highlight the importance of national prevention efforts to combat the public health impact of excess adiposity.