Introduction Cardiovascular diseases and their metabolic risk factors including overweight and obesity, blood pressure, cholesterol, and glucose have been predicted to rise with increasing income, originally referred to as the “diseases of affluence” paradigm. Our aim was to examine the associations between metabolic risk factors and national income since 1980.

Methods We used estimates of age-standardised mean body mass index (BMI), systolic blood pressure (SBP), serum total cholesterol (TC) and fasting plasma glucose from a pooled analysis of population-based data. We assesses associations between risk factor levels and national income, measured as annual per-capita GDP converted to international dollars in 1990 and urbanisation, as proportion of a country's population that lived in urban areas in 1980, 1990, 2000, and 2008.

Results In 1980, all four risk factors were associated with national income, with the association stronger for TC and BMI, and weaker for SBP and fasting plasma glucose. In 2008, TC was the only risk factor with strong association. BMI was highest in mid-income countries and SBP had an inverse association.

Conclusions The burden of metabolic risk factors has increasingly shifted to low- and middle-income countries, especially for SBP.