Identifying obese women most at risk from cardiovascular disease

In Western countries, more women than men die every year of cardiovascular disease (CVD) and women spend more life years with cardiovascular disease than men. Fortunately, premature cardiovascular disease in women is preventable. Evidence-based guidelines for the prevention of cardiovascular disease in women recommend an initial risk assessment. However, recommended risk-assessment tools such as the Systematic Coronary Risk Evaluation (SCORE) system may not be sufficient to detect risk in women with obesity. A further barrier to prevention in women is the fact that physicians may underestimate the effects of risk factors that are particularly dangerous or prevalent in women. These include type 2 diabetes, hypertension, smoking, abdominal obesity, poor exercise capacity and the metabolic syndrome. Several of these factors, as well as some novel biomarkers, may increase the risk of cardiovascular disease relatively more in women than in men. To assess risk in obese women, a multifactorial assessment that encompasses assessment of body-fat distribution should be undertaken. Weight loss and lifestyle changes that have been shown to improve risk-factor profiles are crucial interventions and should be considered, even if standard risk calculators do not indicate an elevated cardiovascular risk.