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Burden and Rates of Treatment and Control of Cardiovascular Disease Risk Factors in Obesity

The Framingham Heart Study

¹ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
² Municipal Health Service Utrecht, Utrecht, the Netherlands
³ National Heart, Lung and Blood Institute's Framingham Heart Study, Framingham, Massachusetts
⁴ Department of Cardiology and Preventive Medicine, Boston University School of Medicine, Boston, Massachusetts
⁵ Division of General Internal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
⁶ Department of Mathematics and Statistics, Boston University, Boston, Massachusetts
⁷ Department of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts

Corresponding author: Caroline S. Fox, foxca{at}nhlbi.nih.gov

OBJECTIVE— Obesity is associated with an increased risk for cardiovascular disease (CVD). We sought to determine rates of treatment and control of CVD risk factors among normal weight, overweight, and obese individuals in a community-based cohort.

RESEARCH DESIGN AND METHODS— Participants free of CVD (n = 6,801; mean age 49 years; 54% women) from the Framingham Offspring and Third Generation cohorts who attended the seventh Offspring examination (1998–2001) or first Third Generation (2002–2005) examination were studied.

RESULTS— Obese participants with hypertension were more likely to receive antihypertensive treatment (62.3%) than normal weight (58.7%) or overweight (59.0%) individuals (P = 0.002), but no differences in hypertension control across BMI subgroups among participants with hypertension were observed (36.7% [normal weight], 37.3% [overweight], and 39.4% [obese]; P = 0.48). Rates of lipid-lowering treatment were higher among obese participants with elevated LDL cholesterol (39.5%) compared with normal weight (34.2%) or overweight (36.4%) participants (P = 0.02), but control rates among those with elevated LDL cholesterol did not differ across BMI categories (26.7% [normal weight], 26.0% [overweight], and 29.2% [obese]; P = 0.11). There were no differences in diabetes treatment among participants with diabetes across BMI groups (69.2% [normal weight], 50.0% [overweight], 55.0% [obese]; P = 0.54), but obese participants with diabetes were less likely to have fasting blood glucose <126 mg/dl (15.7%) compared with normal weight (30.4%) or overweight (20.7%) participants (P = 0.02).

CONCLUSIONS— These findings emphasize the suboptimal rates of treatment and control of CVD risk factors among overweight and obese individuals.

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