The age associations of blood pressure, cholesterol, and glucose: analysis of health examination surveys from international populations

Abstract

Background: The age association of cardiovascular disease may be in part because its metabolic risk factors tend to rise with age. Few studies have analyzed age associations of multiple metabolic risks in the same population, especially in nationally representative samples. We examined worldwide variations in the age associations of systolic blood pressure (SBP), total cholesterol (TC), and fasting plasma glucose (FPG).

Methods and results: We used individual records from 83 nationally or subnationally representative health examination surveys in 52 countries to fit a linear model to risk factor data between ages 30 and 64 years for SBP and FPG, and between 30 and 54 years for TC. We report the cross-country variation of the slope and intercept of this relationship. We also assessed nonlinear associations in older ages. Between 30 and 64 years of age, SBP increased by 1.7 to 11.6 mm Hg per 10 years of age, and FPG increased by 0.8 to 20.4 mg/dL per 10 years of age in different countries and in the 2 sexes. Between 30 and 54 years of age, TC increased by 0.2 to 22.4 mg/dL per 10 years of age in different surveys and in the 2 sexes. For all risk factors and in most countries, risk factor levels rose more steeply among women than among men, especially for TC. On average, there was a flattening of age-SBP relationship in older ages; TC and FPG age associations reversed in older ages, leading to lower levels in older ages than in middle ages.

Conclusions: The rise with age of major metabolic cardiovascular disease risk factors varied substantially across populations, especially for FPG and TC. TC rose more steeply in high-income countries and FPG in the Oceania countries, the Middle East, and the United States. The SBP age association had no specific income or geographical pattern.

Figure 1

Distributions of age-association slopes and intercepts of SBP, TC, and FPG. Each box plot shows distributions for all analyzed surveys.

Figure 2

Age-association slopes and intercepts of SBP, TC, and FPG for males vs. females. Each data point represents an analyzed survey. The outliers and extremes are identified. See Table S2 for numerical information for all surveys.

Figure 3

Average risk factor level by age in groups of surveys. Survey groups were formed based on whether slope between 30 and 64 years for SBP and FPG (30-54 years for TC) was in the lowest, middle, or highest tertile (SBP) or below/above median (TC and FPG).