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Assessment/Diagnosis
Risk Factors
• Modif iable risk factors include obesity (each 5 kg/m² BMI increase
raises ASCVD risk by 29%), waist circumference >102 cm (men)
or >88 cm (women) dyslipidemia (apoB-containing lipoproteins,
LDL-C ≥70 mg/dL in high-risk patients), hypertension (BP
≥130/80 mm Hg), sedentary lifestyle, diets high in trans fats or
ref ined sugars, and smoking. Nonmodif iable factors include
older age, with risk doubling every decade after 40, genetic
predispositions such as familial hypercholesterolemia, Black race,
with higher mortality driven by both social determinants of health
and biological contributors like elevated lipoprotein (a) levels.
Cardiovascular Complications
Atherosclerotic Cardiovascular Disease
➤ Obesity accelerates ASCVD through visceral adiposity-driven
inflammation, insulin resistance, and dyslipidemia, which
impair endothelial function, promote foam cell formation and
platelet aggregation, and increase plaque instability via reduced
adiponectin and increased oxidative stress.
➤ Clinical Manifestations
• Cardiovascular signs and symptoms in individuals with obesity
include angina, myocardial infarction, or heart failure with preserved
ejection fraction. Obesity sometimes obscures typical symptoms,
and patients present with exertional dyspnea; cerebrovascular
disease such as transient ischemic attack, ischemic stroke, or
vascular dementia; and peripheral artery disease characterized
by intermittent claudication, nonhealing ulcers, or critical limb
ischemia. Notably, up to 40% of adults with obesity may harbor
asymptomatic atherosclerotic plaques detectable only through
imaging, underscoring the prevalence of subclinical disease.
➤ Screening
• Adults with obesity (BMI ≥30 kg/m²) or MetS should undergo
cardiovascular risk screening beginning at age 19 years, including
a lipid panel every three to f ive years (annually if LDL-C is ≥130
mg/dL) and American Heart Association Predicting Risk of
cardiovascular disease EVENTs (PREVENT™) equations, with
obesity considered a risk-enhancing factor. CAC (coronary artery
calcium) scoring in men at least 40 years of age and women at
least 45 years of age can improve risk assessment and guide
LDL-C and non–HDL-C goals. The 2025 ACC/AHA updates
recommend measuring apolipoprotein B or LDL particle number
as secondary lipid targets in individuals with triglycerides ≥150
mg/dL and advise screening for obstructive sleep apnea in
patients with obesity and resistant hypertension.
