Long-term studies are needed to establish obesity itself as a risk factor for cardiovascular disease, even though other well-known risk factors are prevalent in obese persons. It is possible that the risk for cardiovascular disease is found in a subgroup of the total obesity population. Cross-sectional studies have shown abdominal obesity to be strongly associated with risk factors for cardiovascular disease. Prospective epidemiologic studies in men and women have shown that abdominal obesity is associated with increased risk for ischemic heart disease, stroke, and death independent of the total degree of obesity. Even limited abdominal obesity should be treated and patients examined carefully for complicating conditions.