Epidemiology has taught the profession that clinical medicine entails a probabilistic approach. Inherent in the concept of risk is the realization that not all persons at risk develop disease and that some persons without identifiable risk do. The predictive value of risk factors for disease can, nonetheless, be refined, and such refinement may enhance their usefulness. Cholesterol level is a risk factor for coronary artery disease, but the predictive value is markedly enhanced by fractionating total cholesterol into low-density and high-density lipoprotein components. The same is true for obesity. Two articles in this issue of the Archives (Stefan et al1 and Wildman et al2) present data that seek to further refine the well-known cardiovascular risk imposed by obesity.
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