Obesity and Associated Coronary Heart Disease Risk Factors in a Population of Low-Income African-American and White Women: The North Carolina WISEWOMAN Project 1 Tracy L. Nelson, Ph.D., MPH,* , † Kelly J. Hunt, Ph.D.,* Wayne D. Rosamond, Ph.D.,* Alice S. Ammerman, Dr.P.H., R.D.,‡ Thomas C. Keyserling, M.D., Ph.D.,§ Ali H. Mokdad, Ph.D., ¶ and Julie C. Will, Ph.D. ¶ *Department of Epidemiology and ‡Department of Nutrition, School of Public Health, and §Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; †Department of Health and Exercise Science, Colorado State University, Fort Collins, Colorado; and ¶ Division of Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia Background. Obesity has been associated with many co-occurring coronary heart disease (CHD) risk fac- tors as well as CHD mortality. These associations have been shown to vary between African-American and white sample populations. Methods. The authors examined whether obesity co- occurs with several CHD risk factors (diabetes, hyper- tension, hypercholesterolemia, low high-density li- poprotein cholesterol (HDL-C)), and estimated the 10- year risk for CHD in the North Carolina WISEWOMAN (Well Integrated Screening and Evaluation for Women Across the Nation) study sample. This sample includes low-income African-American and white women (>50 years of age). Results. Among white women (n  1,284), 34% were overweight (BMI  25.0 –29.99 kg/m 2 ) and 35% obese (BMI > 30 kg/m 2 ); among African-American women (n  754), 28% were overweight and 59% obese. Among obese and nonobese African-American women, the prevalence of three or more co-occurring risk factors was similar (obese  17.7% (95% confidence interval (CI): 13.9, 21.6) and nonobese  13.3% (95% CI: 8.7, 17.8)). By contrast, the prevalence among white women was greater among the obese (26.9% (95% CI: 22.9, 31.0)) than the nonobese (13.0% (95% CI: 9.7, 16.2)). Conclusions. The differences between and within African-American and white women may be accounted for by the high levels of HDL-C among obese and non- obese African-American women. © 2002 American Health Foundation and Elsevier Science (USA) Key Words: African-American women; coronary heart disease; risk factors; high-density lipoprotein cholesterol; obesity. INTRODUCTION Obesity and overweight continue to be a major public health problem affecting more than half of the adult U.S. population [1]. Data from the National Health and Nutrition Examination Surveys (NHANES) clearly show that the prevalence of obesity is on the rise. For example, Flegal and colleagues [1] showed obesity in- creased from 14.5 to 22.5% between NHANES II (1976 –1980) and III (1988 –1994). Mokdad and associ- ates [2] have recently shown, using the Behavioral Risk Factor Surveillance System, the greatest increase in obesity from 1991 to 1998 was in 18- to 29-year-olds, those with some college education, and those of His- panic ethnicity. They also found the increase in obesity varied across the United States by region and state. Obesity is associated with high blood pressure, type II diabetes, low levels of high-density lipoprotein cho- lesterol (HDL-C), and hypertriglyceridemia, all known risk factors for cardiovascular disease (CVD) [3,4]. The lifetime risks of heart disease are much higher for individuals who are obese. The risk of developing heart disease increases, for women aged 45–54 years, from 26% in the nonobese to 37% in the obese [5]. The prevalence and the associated risk factors of overweight and obesity have been shown to vary by age, sex, socioeconomic status, and race. For example, the health risks of obesity tend to increase up to age 74 and then decline, females tend to have higher rates of obesity than do males [6,7], and persons of lower socio- economic status tend be more obese then those of 1 Funding provided by a grant from the Centers for Disease Con- trol and Prevention through a subcontract with the North Carolina State Department of Health and Human Services. Reprint requests should be addressed at Colorado State Univer- sity, Department of Health and Exercise Science, 218 F Moby, Fort Collins, CO 80523-1582. Preventive Medicine 35, 1– 6 (2002) doi:10.1006/pmed.2002.1042 1 0091-7435/02 $35.00 © 2002 American Health Foundation and Elsevier Science (USA) All rights reserved.