The Importance of Obesity in the Development of Coronary Risk Factors and Disease: The Epidemiologic Evidence

Coronary heart disease (CHD) is caused by a complex interaction of genetic and life-style factors that begin to exert their effects many years prior to diagnosis of the disease. Numerous epidemiologic studies in middle-aged populations have shown the importance of attributes such as elevated blood pressure and blood lipids in the etiology of CHD; as a result, intervention in high-risk individuals has been focused on reduction of risk factors with pharmacologic treatment and a modified-fat diet. While such approaches to risk reduction are important and can decrease mortality, it is also clear that optimal preventive strategies will require modification of early markers for the development of CHD, hyperten­ sion, and hyperlipidemia. The accumulated evidence strongly suggests that overweight or obesity is such a precursor to disease development and that prevention of CHD can be greatly promoted by the control of this attribute in overfed and sedentary populations such as those in North America.