Examine obese patients for these risk factors
Examine morbidly obese patients for the presence of the following risk factors, according to the Bethesda, MD-based National Heart, Blood, and Lung Institute:1
• Cardiovascular risk factors. Cigarette smoking, hypertension (systolic blood pressure > 140 mm Hg or diastolic blood pressure > 90 mm Hg, or the patient is taking antihypertensive agents), high-risk LDL-cholesterol (> 160 mg/dL), low HDL-cholesterol (< 35 mg/dL), impaired fasting glucose (fasting plasma glucose of 110 to 125 mg/dL), family history of premature coronary heart disease (CHD) (definite myocardial infarction or sudden death at or before 55 years of age in father or other male first-degree relative, or at or before 65 years of age in mother or other female first-degree relative), and age (men > 45 years and women > 55 years or post-menopausal).
Patients can be classified as being at high absolute risk if they have three of the aforementioned risk factors. Patients at high absolute risk usually require clinical management of risk factors to reduce risk.
Patients who are overweight or obese often have other cardiovascular risk factors. The intensity of intervention for cholesterol disorders or hypertension is adjusted according to the absolute risk status estimated from multiple risk correlates. These include both the risk factors listed above and evidence of end-organ damage present in hypertensive patients. Approaches to therapy for cholesterol disorders and hypertension are described in the Second Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults and the Sixth Report of the Joint National Committee on Prevention, Detection, and Evaluation of High Blood Pressure, respectively. In overweight patients, control of cardiovascular risk factors deserves equal emphasis as weight reduction therapy. Reduction of risk factors will reduce the risk for cardiovascular disease whether or not efforts at weight loss are successful.
• Disease conditions. Established CHD, other atherosclerotic diseases, Type 2 diabetes, and sleep apnea. Patients with those conditions are classified as being at very high risk for disease complications and mortality.
• Other obesity-associated diseases. Gynecological abnormalities, osteoarthritis, gallstones and their complications, and stress incontinence.
• Other risk factors. Physical inactivity and high serum triglycerides (> 200 mg/dL). When those factors are present, patients can be considered to have incremental absolute risk above that estimated from the preceding risk factors. Quantitative risk contribution is not available for those risk factors, but their presence heightens the need for weight reduction in obese persons. (To order the guidelines, see resource box, above.)
Reference
1. National Heart, Blood, and Lung Institute. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report. Bethesda, MD; 1998.
A complete copy of the National Heart, Lung, and Blood Institute (NHLBI) guidelines is available for $8 plus $2 shipping and handling charge. Ask for NIH Publication No. 98-4083. To order a copy, contact:
• NHLBI Information Center, P.O. Box 30105, Bethesda, MD 20824-0105. Telephone: (301) 592-8573. Fax: (301) 592-8563. E-mail: [email protected].
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