SUMMARY The relationship between the degree of obesity and the incidence of cardiovascular disease (CVD) THE IMPORTANCE of body weight, body mass and other measures of adiposity in the prediction of cardiovascular disease (CVD) has been the subject of longstanding debate. Many studies have shown that the incidence of certain types of CVD, particularly coronary heart disease and stroke, is greater in heavier persons,'`but only a few suggest that any obesity index makes an additional contribution to risk once the levels of coexisting risk factors are taken into account. '.2'4 Obesity is associated with elevated blood pressure, blood lipids and blood glucose,7 1 and changes in body weight are coincident with changes in these risk factors for disease.", 113 Thus, the consensus has been that the increased risk among heavier persons is due primarily to the influence of the associated risk factor profile and not to the degree of obesity per se. The existing data have also been interpreted to suggest that obesity is benign when it exists without other major risk factors for CVD.In this report, we reexamine the obesity question and describe the influence of relative weight on the 26-year incidence of CVD in Framingham men and women. Earlier results from this study suggested that the degree of obesity is not a potent independent risk factor for CVD in general, particularly among women. 14, 15 However, these conclusions were based on analyses of the influence of relative weight over shorter periods of follow-up and may not have conveyed the true impact of disease risk.Such a reevaluation appears timely in view of the current revisions to the original Metropolitan Life In-

The Framingham Heart Study (FHS) was started in 1948 as a prospective investigation of cardiovascular disease in a cohort of adult men and women. Continuous surveillance of this sample of 5209 subjects has been maintained through biennial physical examinations. In 1971 examinations were begun on the children of the FHS cohort. This study, called the Framingham Offspring Study (FOS), was undertaken to expand upon knowledge of cardiovascular disease, particularly in the area of familial clustering of the disease and its risk factors. This report reviews the sampling design of the FHS and describes the nature of the FOS sample. The FOS families appear to be of typical size and age structure for families with parents born in the late 19th or early 20th century. In addition, there is little evidence that coronary heart disease (CHD) experience and CHD risk factors differ in parents of those who volunteered for this study and the parents of those who did not volunteer.

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