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Guidelines on Overweight and Obesity: Electronic Textbook
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Identification of Patients at Very High Absolute Risk

The following disease conditions or target organ damage in hypertensive patients denotes the presence of very high absolute risk that triggers the need for intense risk factor modification as well as disease management. For example, the presence of very high absolute risk indicates the need for aggressive cholesterol-lowering therapy (142).

a. Established coronary heart disease (CHD)

  • History of myocardial infarctionGraphic of organ systems affected by absolute risk
  • History of angina pectoris (stable or unstable)
  • History of coronary artery surgery
  • History of coronary artery procedures (angioplasty)

b. Presence of other atherosclerotic diseases

  • Peripheral arterial disease
  • Abdominal aortic aneurysm
  • Symptomatic carotid artery disease

c. Type 2 diabetes

d. Sleep apnea

Identification of other obesity-associated diseases

Obese patients are at increased risk for several conditions that require detection and appropriate management, but that generally do not lead to widespread or life-threatening consequences. These include:

  • Gynecological abnormalities
  • Osteoarthritis
  • Gallstones and their complications
  • Stress incontinence

Although obese patients are at increased risk for gallstones, this risk increases even more during periods of rapid weight reduction.

Management options of risk factors for preventing CVD, diabetes mellitus, and other chronic diseases are described in detail in other reports.  For details on the management of serum choleserol and other lipoprotein disorders, refer to the National Cholesterol Education Program's Second Report of the Expert Panel on the Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II/ATP II) (1993) (142). For the treatment of hypertension, the National High Blood Pressure Education Program recently issued the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) (1997) (545). For the most recent recommendations about type 2 diabetes from the American Diabetes Asociation, see the ADA Clinical Practice Recommendations (1998) (546).  Finally, smoking cessation is strongly recommended in obese smokers, with particular attention to methods that diminish the weight gain associated with cessation.  For strategies and recommendations for supporting and delivering effective smoking cessation intervention, see the Agency for Health Care Policy and Research's Clinical Practice Guidelines on Smoking Cessation (547).
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