Assessment of Risk Factors

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Overall, the greatest danger of overweight/obesity is the development of cardiovascular disease. Moreover, in the long term obesity predisposes to type 2 diabetes, which is itself a risk factor for cardiovascular disease. ATP III provides useful classifications for lipid and nonlipid risk factors. These classifications are shown in Tables 1 and 2, respectively. In ATP III, estimates are made of a person's absolute risk using Framingham risk scoring, which is available through the NHLBI (http:// htm). This scoring estimates the 10-year risk for developing myocardial infarction or coronary death. It is based on absolute levels of the following risk factors: total cholesterol, HDL cholesterol, blood pressure, smoking history, and age. Framingham scoring can be carried out either by manual scoring or with a simple computer program, both of which are available on the NHLBI website. In addition, ATP III defines the metabolic syndrome for clinical practice according to five clinical features (Table 3). According to ATP III, three of five of these clinical features constitute a clinical diagnosis of the metabolic syndrome. In addition, however,

Table 3 Clinical Identification of the Metabolic

Syndrome—Any Three of the Following

Table 3 Clinical Identification of the Metabolic

Syndrome—Any Three of the Following

Risk factor

Defining level

Abdominal obesitya

Waist circumferenceb


>102 cm (>40 in)


>88 cm (>35 in)


>150 mg/dL

HDL cholesterol

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