Obesity and the risk of cardiovascular disease.

The original notion that obesity is associated with disease and premature death was obtained from insurance statistics, which have been rightfully criticized for representing selected populations. In prospective, epidemiological studies a long period of observation on a large number of subjects is needed before obesity can be recognized as a risk factor for cardiovascular disease in spite of the fact that well-known risk factors for such disease are prevalent in obesity populations. This apparent paradox may be explained by the possibility that the risk of getting cardiovascular disease is present mainly in a subgroup of the total obese population. Such a subgroup might be characterized by the distribution of adipose tissue. Indeed abdominal obesity has been demonstrated consistently to be strongly associated with risk factors for cardiovascular disease in cross-sectional investigations of older and more recent dates. Several prospective longitudinal, epidemiological studies in both men and women have shown that abdominal obesity is associated with an increased risk of getting ischemic heart disease, stroke and death, independent of the total degree of obesity. The findings from these recent prospective studies, supported by previous unanimous cross-sectional studies as well as the fact that reasonable potential explanations for the statistical associations have been suggested, now seem to allow the conclusion that abdominal obesity should even be treated when present to a very limited extent. In such subjects, exclusion of conditions complicating obesity should also be performed vigorously. Abdominal obesity can be diagnosed by very simple means: measuring the abdominal circumference in relation to hip circumference.(ABSTRACT TRUNCATED AT 250 WORDS)