European Journal of Cardiovascular Medicine

Cardiovascular diseases (CVDs) continue to be the leading cause of death globally, accounting for an estimated 17.9 million deaths per year.¹ The middle-aged population, typically defined as those between 45 and 65 years old, is particularly susceptible to developing cardiovascular risk factors that can lead to serious health complications later in life. This study aims to comprehensively assess these risk factors through a longitudinal observational approach, which can offer valuable insights for early intervention and prevention strategies.

The prevalence of CVDs and their associated risk factors among middle-aged adults has been well-documented. Common risk factors include hypertension, dyslipidemia, diabetes, obesity, smoking, and physical inactivity.² These factors often co-occur, creating a compounded risk for individuals. For example, hypertension is a major contributor to cardiovascular morbidity and mortality, affecting approximately 50% of middle-aged adults in developed countries.³ Elevated blood pressure can lead to various complications, such as heart attack, stroke, and kidney failure.

Dyslipidemia, characterized by abnormal levels of lipids in the blood, is another critical risk factor. High levels of low-density lipoprotein (LDL) cholesterol and low levels of high-density lipoprotein (HDL) cholesterol are strongly associated with an increased risk of CVD. Diabetes, particularly type 2 diabetes, doubles the risk of cardiovascular events and is prevalent in the middle-aged demographic.⁴ Furthermore, obesity, defined by a body mass index (BMI) of 30 or higher, has seen a dramatic increase globally, further exacerbating cardiovascular risks.⁵

Previous research has extensively examined individual cardiovascular risk factors, but there is a relative paucity of longitudinal studies focusing on the progression of these factors in middle-aged adults. Emphasized the importance of long-term risk assessment and continuous monitoring to predict better and manage cardiovascular risk.⁶ Similarly, highlighted the disparities in risk factor prevalence and the need for comprehensive public health efforts to address these issues.⁷

Updated cholesterol management guidelines, underscoring the importance of aggressive treatment for individuals with multiple risk factors.⁸ Their work highlights the interconnected nature of cardiovascular risks and the necessity of a multifaceted approach to prevention. Furthermore, the provided evidence linking diabetes management to significant reductions in cardiovascular events, reinforcing the critical role of monitoring and managing this risk factor in middle-aged adults.⁹

This longitudinal observational study aims to bridge the gap in understanding the development and interaction of cardiovascular risk factors in middle-aged adults.¹⁰ By providing a detailed analysis of these risk factors over time, the study seeks to inform effective prevention and intervention strategies, ultimately contributing to reducing CVD incidence and improving public health outcomes. The insights gained from this research will be crucial for healthcare providers, policymakers, and public health professionals in their efforts to combat the growing epidemic of cardiovascular diseases.

OBJECTIVES

General Objective

• Assess the progression of cardiovascular risk factors in middle-aged adults over five years to guide prevention strategies.

Specific Objectives

• Determine the prevalence and trends of key cardiovascular risk factors.
• Examine interrelationships among risk factors.
• Monitor changes over five years.
• Compare risk factors between urban and rural populations.
• Identify early indicators for intervention.
• Inform public health strategies.

This study employs a longitudinal observational design to assess cardiovascular risk factors in middle-aged adults. A cohort of 522 participants, aged 40-65, was selected through stratified random sampling from both urban and rural areas, ensuring representativeness. Baseline data collection commenced in June 2019 at the Department of Cardiology, Hi-Tech Medical College & Hospital, Bhubaneswar, India, with annual follow-up assessments conducted until June 2024. Key variables measured include blood pressure, lipid profiles, fasting glucose levels, body mass index (BMI), smoking status, and physical activity levels. Data analysis involves paired t-tests to compare baseline and follow-up data.

Inclusion Criteria

• Age between 40 and 65 years.
• Resident of the area served by Hi-Tech Medical College & Hospital, Bhubaneswar, India.
• Willingness to participate and provide informed consent.
• Able to attend annual follow-up assessments for the study duration.
• No prior diagnosis of cardiovascular diseases at baseline.

Exclusion Criteria

• Age below 40 or above 65 years.
• Non-residents of the area are served by Hi-Tech Medical College & Hospital.
• Unable or unwilling to provide informed consent.
• Inability to attend annual follow-up assessments.
• Prior diagnosis of cardiovascular diseases or undergoing treatment for CVD at baseline.
• Severe comorbid conditions that may affect participation (e.g., advanced cancer, severe psychiatric disorders).

Data Collection

Baseline data collection began in June 2019 and included comprehensive health assessments at the Department of Cardiology, Hi-Tech Medical College & Hospital, Bhubaneswar, India. Key measurements included blood pressure, lipid profiles, fasting glucose levels, and body mass index (BMI). Participants also completed validated questionnaires regarding smoking status and physical activity levels. Annual follow-up assessments are conducted to monitor changes in these parameters. Data is recorded and managed using standardized protocols to ensure accuracy and reliability. Statistical analysis, including paired t-tests, will be used to compare baseline and follow-up data to assess the progression of cardiovascular risk factors.

Data Analysis

Data analysis was conducted using SPSS version 26. Descriptive statistics were used to summarize the baseline characteristics of the cohort. Paired t-tests were employed to compare changes in cardiovascular risk factors over the five-year study period. Categorical variables, such as smoking status and physical activity levels, were analyzed using chi-square tests. Pearson correlation coefficients were calculated to assess the interrelationships between risk factors. Significance was set at a p-value of <0.05. Multivariable regression analysis was performed to identify predictors of increased cardiovascular risk, controlling for potential confounders.

Ethical Considerations

The Institutional Ethics Committee of Hi-Tech Medical College approved this study. All participants provided written informed consent before enrollment. Confidentiality of participant data was maintained by anonymizing records and securely storing data. Participants were informed of their right to withdraw from the study at any time without any consequence. The study adhered to the ethical principles outlined in the Declaration of Helsinki

The study included 522 middle-aged adults, with a mean age of 52 years (range 40-65 years). Baseline characteristics, including the prevalence of hypertension, dyslipidemia, diabetes, obesity, smoking, and physical inactivity, were recorded. The following tables summarize the key findings from the baseline and follow-up assessments over the five-year study period.

Table 1: Demographic Characteristics According to Socioeconomic Status

Demographic characteristics according to socioeconomic status (SES). Middle and high SES groups have higher mean ages (52 and 53 years, respectively) compared to low SES (45 years). Gender distribution is similar across SES groups. Hypertension and dyslipidemia are slightly higher in the middle SES group. Obesity, diabetes, and smoking rates are relatively consistent across all groups. Physical inactivity is highest in the low SES group (63%), highlighting SES-related health disparities.

The gender distribution of the study participants shows a slight male predominance, with 53% male and 47% female participants. This balanced representation ensures that the findings are relevant to both genders, although the slightly higher number of males may reflect broader demographic trends or specific recruitment outcomes.

In the first-year follow-up, 57% of participants had hypertension, 48% had dyslipidemia, 41% were obese, 31% had diabetes, 24% were smokers, and 60% were physically inactive. All risk factors showed statistically significant prevalence (p < 0.05). This indicates a high burden of cardiovascular risk factors among the cohort, necessitating targeted interventions.

Table 2: Baseline Prevalence of Cardiovascular Risk Factors

At baseline, 55% of participants had hypertension, 47% had dyslipidemia, 40% were obese, 30% had diabetes, 25% were smokers, and 60% were physically inactive. All these risk factors were significantly prevalent (p < 0.05). The high baseline prevalence underscores the critical need for early intervention and continuous monitoring to mitigate the risk of cardiovascular diseases in this population.

Table 3: Comparison of Risk Factors Between Urban and Rural Populations at Year 5

At year 5, urban populations exhibited higher rates of hypertension (65% vs. 55%), dyslipidemia (55% vs. 49%), obesity (50% vs. 40%), and diabetes (38% vs. 32%) compared to rural populations. Conversely, smoking was slightly less prevalent in urban areas (20% vs. 24%). Physical inactivity was higher in urban populations (62% vs. 58%). These statistically significant differences highlight the need for targeted interventions considering urban-rural health disparities.

At the five-year follow-up, the prevalence of hypertension increased to 60%, dyslipidemia to 52%, obesity to 45%, and diabetes to 35%. Smoking prevalence decreased slightly to 22%, while physical inactivity remained constant at 60%. These statistically significant changes (p < 0.01), indicate a growing burden of cardiovascular risk factors over time. This underscores the need for sustained public health efforts and lifestyle interventions to curb the rising trend of these risk factors.

Table 4: Multivariable Regression Analysis of Cardiovascular Risk Factors

The multivariable regression analysis indicates significant associations between cardiovascular risk factors and their prevalence. Hypertension (B=1.23, p<0.01), dyslipidemia (B=1.15, p<0.01), obesity (B=1.10, p<0.01), and diabetes (B=1.30, p<0.01) show strong positive correlations with increased cardiovascular risk. Smoking (B=0.90, p<0.05) and physical inactivity (B=1.05, p<0.03) also significantly contribute to risk, though to a lesser extent. These findings underscore the importance of addressing these modifiable risk factors to reduce cardiovascular disease burden.

Table 5: Five-Year Follow-Up of Cardiovascular Risk Factors Prevalence (2019-2024)

Over five years, hypertension prevalence increased from 55% to 60%, dyslipidemia from 47% to 52%, obesity from 40% to 45%, and diabetes from 30% to 35%. Smoking rates slightly decreased from 25% to 22%, while physical inactivity remained constant at 60%. All changes were statistically significant (p < 0.01), indicating a worsening cardiovascular risk profile among the cohort.

This longitudinal observational study assessed the progression of cardiovascular risk factors in middle-aged adults over a five-year period.¹¹ The results indicated a significant increase in the prevalence of hypertension, dyslipidemia, obesity, and diabetes among the study cohort, while smoking rates slightly decreased and physical inactivity remained consistently high. These findings underscore the growing burden of cardiovascular risk factors in this demographic, which aligns with global trends observed in similar studies.

The prevalence of hypertension in our study increased from 55% at baseline to 60% at Year 5 (p < 0.01). This rise is consistent with findings from the Framingham Heart Study, which reported an increasing trend in hypertension among middle-aged adults.¹² The significant increase could be attributed to aging, lifestyle factors such as high sodium intake, and stress. The high baseline prevalence and subsequent increase highlight the urgent need for targeted interventions to control blood pressure in this population, including lifestyle modifications and medication adherence.

Dyslipidemia prevalence rose from 47% at baseline to 52% by Year 5 (p < 0.01). This trend aligns with the National Health and Nutrition Examination Survey (NHANES), which found similar patterns in the U.S. adult population.¹³ Elevated cholesterol levels are closely linked to dietary habits, obesity, and genetic factors. The rise in dyslipidemia in our study population underscores the importance of dietary interventions, regular monitoring, and potentially pharmacological treatment to manage lipid levels effectively.

Obesity prevalence increased from 40% to 45% over the study period (p < 0.01). This mirrors global trends reported by the World Health Organization (WHO), highlighting a growing obesity epidemic.¹⁴ The rise in obesity can be attributed to sedentary lifestyles, unhealthy eating patterns, and genetic predispositions. Addressing obesity through public health initiatives focusing on nutrition education, physical activity promotion, and weight management programs is critical to reducing cardiovascular risk.

The prevalence of diabetes in our cohort rose from 30% to 35% (p < 0.01). This is consistent with global trends indicating an increase in diabetes prevalence among middle-aged adults.¹⁵ The rise can be linked to obesity, sedentary lifestyles, and genetic factors. Early detection and management through lifestyle changes, glucose monitoring, and medication are essential to mitigate the risk of cardiovascular complications associated with diabetes.

Smoking prevalence decreased slightly from 25% to 22% (p < 0.01). This decline is encouraging and reflects global anti-smoking campaigns and public health policies.¹⁶  However, the persistent prevalence indicates that more efforts are needed to reduce smoking rates further. Continued public health campaigns, smoking cessation programs, and policy measures are vital to sustaining this downward trend.

Physical inactivity remained high at 60% throughout the study period (p < 0.03). This is concerning, given the well-established link between physical inactivity and increased cardiovascular risk.¹⁷ The high and stable prevalence of inactivity suggests that current public health efforts may be insufficient. Innovative strategies to promote physical activity, such as community-based exercise programs and workplace wellness initiatives, must address this risk factor effectively.

Comparison with Existing Literature

Our findings align with those from other studies but also show differences that various factors could explain. For instance, the Framingham Heart Study reported similar trends in hypertension and dyslipidemia but had a lower obesity prevalence. Differences in sample size, demographics, and geographic regions could account for these variations. Our study was conducted in Bhubaneswar, India, which may have different environmental, dietary, and genetic influences compared to Western populations studied in the Framingham and NHANES studies.¹⁸ The NHANES study also reported a decline in smoking rates, similar to our findings. However, the decline was more pronounced in the NHANES study, potentially due to more aggressive anti-smoking policies and greater public awareness in the U.S. compared to India. Additionally, our study's stable high prevalence of physical inactivity contrasts with some reports of decreasing inactivity rates in developed countries. This difference might be due to varying levels of infrastructure and cultural attitudes towards exercise between countries.

Implications for Public Health and Clinical Practice

The rising prevalence of cardiovascular risk factors in middle-aged adults necessitates urgent public health and clinical interventions. Early detection and management are vital to preventing cardiovascular diseases and reducing associated morbidity and mortality.¹⁹ Key areas for intervention include hypertension management through regular blood pressure monitoring and lifestyle changes, lipid control with dietary interventions and lipid-lowering agents, and obesity management via comprehensive weight programs. Diabetes management should emphasize early screening, lifestyle interventions, and tight glucose control. Smoking cessation efforts must continue through public health campaigns, cessation programs, and policy measures. Lastly, promoting physical activity through community-based programs, workplace wellness initiatives, and infrastructure development is crucial to combating physical inactivity.^20,21 Public health initiatives and clinical practices must integrate these strategies to effectively address the growing cardiovascular health burden.

This study highlights the increasing prevalence of cardiovascular risk factors in middle-aged adults in Bhubaneswar, India, over five years. The significant rise in hypertension, dyslipidemia, obesity, and diabetes, coupled with persistently high physical inactivity rates, underscores the urgent need for targeted public health interventions. Comparisons with other studies suggest regional differences in lifestyle, environmental factors, and public health policies may influence these trends. Addressing these risk factors through comprehensive public health strategies and clinical interventions is crucial to reducing the burden of cardiovascular diseases and improving population health.

This study highlights the increasing prevalence of cardiovascular risk factors—hypertension, dyslipidemia, obesity, and diabetes—among middle-aged adults over five years. The findings emphasize the need for early, targeted intervention strategies to mitigate these risks. Public health initiatives should focus on lifestyle modifications, continuous monitoring, and comprehensive public health strategies to reduce the burden of cardiovascular diseases and improve overall population health. The insights gained are crucial for healthcare providers, policymakers, and public health professionals.

Recommendations

Implement community programs for healthy eating, exercise, and smoking cessation.

Regular health screenings for middle-aged adults to manage risk factors early.

Create policies to reduce sodium in foods and increase access to recreational facilities.

Acknowledgment

We express our gratitude to the Department of Cardiology at Hi-Tech Medical College & Hospital, Bhubaneswar, for their support. We thank all participants for their valuable cooperation. Special thanks to the research team for their dedication and hard work in data collection and analysis.

Author contributions

Professor Dr. Akshaya Kumar Samal led the study design, data analysis, and manuscript preparation. Dr. Deepak Narayan Lenka contributed to data collection, statistical analysis, and manuscript review. Both authors have read and approved the final manuscript and agree to be accountable for all aspects of the work.

Article at a Glance

Study Purpose: Assess the progression of cardiovascular risk factors in middle-aged adults over five years.

Key Findings: Increased prevalence of hypertension (60%), dyslipidemia (52%), obesity (45%), and diabetes (35%). Smoking decreased slightly, physical inactivity remained high.

Newer Findings Added to What is Known: Urban populations showed more pronounced increases in risk factors. Strong interrelationship between obesity, hypertension, and diabetes suggests compounded cardiovascular risk.

Abbreviations

CVDs: Cardiovascular Diseases

BMI: Body Mass Index

LDL: Low-Density Lipoprotein

HDL: High-Density Lipoprotein

WHO: World Health Organization

NHANES: National Health and Nutrition Examination Survey

Funding: No funding sources

Conflict of interest: None declared

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