203

Original communication

Prevalence of cardiovascular risk

factors among 28,000 employees
Martin Scheerbauma,1, Constantin Langenbacha,1, Petra Scheerbaum1,
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Franziska Heidemann1, Henrik C. Rieß1, Hagen Heigel2, Sebastian E. Debus1

and Christian-Alexander Behrendt1
a
These authors contributed equally to this paper
1
Department of Vascular Medicine, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
2
Heigel GmbH, Hanstedt, Germany

Summary: Background: Cardiovascular diseases are the leading cause of death in Germany. The knowledge of causal risk fac-
tors and their distribution is of utmost importance to design screening programs. Probands and methods: In this cross-section-
al study design we used STROBE criteria to achieve the highest comparability possible. Anthropometric measures (height and
weight), total cholesterol, glucose level, and blood pressure were measured. Probands’ history was collected by using a stand-
ardized questionnaire. The data was age- and gender-adjusted for the working population 16 to 70 years of age, derived from
the micro census, the 1 %-sample census of the German statistical office. For each study year weight factors were calculated.
Logistic regression analysis was conducted regarding the cardiovascular risk factors: smoking, arterial hypertension, diabetes,
hypercholesterolemia, and obesity. Results: Between 2006 and 2015 a total of 28,293 employees took part in the ongoing com-
pany screenings. The mean age was 42.3 years for both sexes (median: 43 years). The mean body mass index (BMI) was 25.6 kg/
m2 (men: 26.5 kg/m2, women: 24.7 kg/m2). A history of hypertension was present in 16 % of the employees (men: 17.8 %, women:
13.8 %). Of the respondents 2 % suffered from diabetes (men: 2.4 %, women: 1.6 %). Lipid-lowering drugs were taken by 2.8 % of
all employees (3.6 % men and 1.9 % women). 23.3 % of the men and women indicated to be active smokers. In the regression
analysis obesity was associated with a four times higher risk of hypertension and a three times higher risk of elevated glucose
levels, thus manifesting as main contributor for vascular diseases. Meanwhile the risk for obesity was 140 % higher in probands
who are former smokers. Conclusions: We regard obesity as the number one cardiovascular risk which should be assessed by
various medical, legislative, and socio-economic actions to limit future mortality and health-care costs in Germany.

Keywords: Cardiovascular risk factors, obesity, blood pressure, diabetes, smoking, employees

Introduction In recent years some authors already took a closer look

Cardiovascular diseases are the leading cause of death in
Germany. The knowledge of causal risk factors and their
distribution in suitable target populations is of utmost im-
portance to design evidence-based screening programs. In
2014, 338,056 deaths in Germany had been caused by car-
diovascular preconditions, thus summing up to 38.9 % of
all deaths in Germany [1].
The risk factors for cardiovascular diseases were first de-
scribed in the Framingham heart study [2, 3]. Today, the
established risk factors are smoking, arterial hypertension,
hypercholesterolemia, diabetes, and obesity. These factors
cause arteriosclerosis, which is the main pathophysiologic
entity of vascular damage. Arteriosclerosis causes diseases
such as peripheral artery disease, myocardial infarction or
carotidal artery stenosis. The crux of arteriosclerosis is its
long presence until the onset of the related diseases [4].
Therefore, detection of the prevalence of cardiovascular
risk factors in younger population groups seems important.
into the adolescent population [5–7]. The risk factor obesity
is of special interest, since it is a rising risk factor that can be
influenced by the individuals themselves [8]. Therefore,
since the early 2000’s, programs have been launched to pre-
vent further growth of obesity among the US population [9].
There is a lot of data on children, adolescents, and el-
derly, but a group often overlooked is the employed popu-
lation between 18 and 65 years of age. Some studies fo-
cused on younger adults, especially in the military services
[10], but their focus mostly is not on the cardiovascular
risk assessment. Apart from that, only few data exist on
the German population [11]. The closest approach in estab-
lishing some kind of registry of the German population is
the DEGS1-Study which focuses on the current health-sta-
tus of the German population [12]. So far, the authors of
the on-going study managed to include 8,152 probands.
As of today, there has been no continuous screening of
cardiovascular risk factors within all age groups of the Ger-
man population. Our aim was to investigate the prevalence

© 2017 Hogrefe Vasa (2017), 46 (3), 203–210

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 204
and possible correlation of cardiovascular risk factors in
the German working population, especially since the num-
ber of obese citizens in Germany is rising [7]. In order to
reach as much probands as possible, we collaborated with
the German company Heigel GmbH which conducts em-
ployee-screenings in German companies. This group of
employees seems to be quite unknown, hence the rate of
physician consultations is minimal. We managed to in-
clude 27,476 probands in our cross-sectional analysis.
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Probands and methods
The STROBE criteria were used throughout this study.
Furthermore, we adjusted our sub headlines in the meth-
ods and results section according to the structure of the
STROBE criteria [13].
Source of data and setting
Heigel GmbH provides a voluntary cardiovascular screen-
ing program for employees in Germany. The services has
been offered to companies with employees ranging from
150 to 65,000. The operational fields of the companies
ranged from financial services to different branches of en-
gineering companies as well as publishing services. The
employees underwent the screening in a standardized
form. Licensed physicians conducted the examination at
the company site by using point of care diagnostics which
were provided by Heigel throughout all screenings. The
participation had been voluntary for the employees. The
screenings were financed by the companies themselves.
We used the anonymized medical data of all conducted
screenings from 2006 until 2015 to form a cross-sectional
analysis of this 10-year time frame.
Study population
Between 2006 and 2015 a total of 28,293 employees par-
ticipated in the ongoing company screenings. After plausi-
bility checks, 27,476 participants aged 16 to 70 years were
included in the cross-sectional analyses. Each participant
was monitored and interviewed just once and corresponds
to one case and consequently to one data set entry.
Definitions of the quantitative variables
Anthropometric measures (height and weight), total choles-
terol, glucose level, and blood pressure were measured by
the licensed physician using on site diagnostics. Patient his-
tory was collected by using a standardized questionnaire.
Obesity: Probands with a body mass index (BMI) of 30 kg/
m2 or higher were declared as obese [14].
Vasa (2017), 46 (3), 203–210
M. Scheerbaum et al., Cardiovascular risk factors in Germany
Total cholesterol: For total cholesterol, we included
n  =   27,342 cases. The critical values of 190  mg/dl (for
hypercholesterolemia) as well as of 240 mg/dl (for severe
hypercholesterolemia) were used [15, 16].
Elevated glucose level: Elevated glucose level was con-
sidered when probands had not eaten for at least eight
hours and reached a glucose level higher than 125 mg/dl or
if the time period of not eating was between two to eight
hours and the glucose level exceeded 200 mg/dl [17].
Elevated blood pressure: The arterial blood pressure was
measured indirectly and non-invasive (Korotkoff method)
after a rest period of five minutes prior to measurement.
Elevated blood pressure was diagnosed, when systolic
blood pressure ≥ 140  mmHg and/or diastolic blood pres-
sure ≥ 90 mmHg was measured [18].
Smoking status: Active smokers have smoked at least 100
cigarettes, former smokers have smoked at least 100 ciga-
rettes and quitted at least 12 months ago; non-smokers
have never smoked.
Composite variables
used in regression analyses
• Hypercholesterolemia: Total cholesterol ≥ 190  mg/dl
measured and/or use of lipid lowering drugs
• Elevated glucose level: elevated glucose level meas-
ured and/or diabetes (in the history)
• Elevated blood pressure: systolic blood pressure
≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg
and/or high blood pressure (in the history)
Statistical analysis
Data were analysed using the statistical package for social
sciences (SPSS 23.0 for Windows). The data were age- and
gender-adjusted for a working population 16 to 70 years of
age, derived from the micro census, the 1 %-sample cen-
sus of the German statistical office. For each study year
weight factors were calculated which later were used for
additional analyses.
Missing or implausible values lead to exclusion of the
entire case. Outliers were defined as missing. Therefore,
the total number of probands varies with each risk factor.
Statistical analyses were conducted regarding the car-
diovascular risk factors: smoking, arterial hypertension,
diabetes, hypercholesterolemia, and obesity. Differences
with p-value  < 0.05 were classified as statistically signifi-
cant. For tables with descriptive statistics, the number of
cases had to be at least n > 10, otherwise the field in the ta-
ble was marked with *. For all analyses, only cases with at
least n ≥ 30 for all values of the investigated variables were
included. The prevalence of the risk factors, which mani-
© 2017 Hogrefe
 M. Scheerbaum et al., Cardiovascular risk factors in Germany
fested differently in gender and age, were tested on statis-
tical significance using contingency tables. Significance
level was identified with Chi-square and its p-values. The
means of BMI and total cholesterol were obtained by the
use of analysis of variance. The significant differences be-
tween the age groups were examined with the Scheffé-Test
and the gender differences were tested using the t-test.
The logistic regression analysis was applied to identify the
effect of the cardiovascular risk factors (obesity, hypercho-
lesterolemia, elevated glucose level, and elevated blood
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pressure) on each other when further covariates (sex, age,
and smoking status) were involved. The logistic regression
stepwise model was applied, while only the independent
variables regarding the covariates with a significance level
of at least p < 0.05 were considered.
Results
Characteristics of the study population
A total of 27,476 probands were included in the cross-sec-
tional data analysis. After adjustments for gender and age,
the distribution was 53.8 % men and 46.2 % women. The
mean age was 42.3 years for both sexes (median: 43 years).
The mean BMI was 25.6 kg/m2 (men: 26.5 kg/m2, women:
24.7  kg/m2). Further baseline characteristics are summa-
rized in Table I.
Obesity
The average BMI of men in each age group was signifi-
cantly higher than the BMI of women (p < 0.001) (Figure 1
panel A). For both sexes, there was a significant increase
of average BMI in the age groups 16–29 and 50–59 years
(p < 0.001). Between the sixth and eighth life decade there
was no significant increase.
The prevalence of obesity was higher in men than in
women in each age group. The number of obese employ-
ees increased with every age group continuously. The rate
of adipose employees rose from 6.8 % (men: 8.2 %, wom-
en: 5.2 %) in the group of 16–29-year-olds to 19.8 % (men:
21.4 %, women: 17.6 %) in the group of 60-years and older.
Total cholesterol
The average total cholesterol was 195.1 mg/dl. The choles-
terol level in women was with 200.2 mg/dl on average sig-
nificantly higher than in men (190.8  mg/dl) (p  < 0.001)
(Figure 1 panel B). We observed gender differences in the
means: while men already in a younger age showed an in-
crease, reaching the maximum mean at the age of 50,
women showed a rather late onset of increase after meno-
pause, reaching their maximum in their 60’s.
For half of the working population (50.9 %) hypercho-
lesterolemia was detected (men: 47.1 %, women: 55.4 %).
In total 15 % were affected by severe hypercholesterolemia
at a level above 240  mg/dl (men: 13 %, women: 17.4 %).
Women in the age group 16–29 and 50+ had a significant
© 2017 Hogrefe
205
higher prevalence of both forms of hypercholesterolemia
than men (p < 0.001).
Lipid lowering drugs
The use of lipid lowering medication rose with age (Fig-
ure 1 panel C). In 49.6 % of the probands, who already
used lipid lowering drugs, hypercholesterolemia was ob-
served (men: 44.2 %, women: 61.4 %); for 15.5 % we even
detected a severe hypercholesterolemia (men: 12.9 %,
women: 21.4 %).
Diabetes and elevated glucose levels
Only 0.5 % of all probands showed elevated glucose lev-
els (men: 0.6 %, women: 0.3 %). But the rate of employ-
ees with a history of diabetes rose with age (Figure 1 panel
D). Interestingly, only 61.9 % of the probands with a his-
tory of diabetes used antidiabetic drugs (men: 65.1 %,
women: 56.2 %).
Elevated glucose levels were found in 14.9 % of probands
who had a history of diabetes. Within this group 19.6 % of
the diabetic probands showed elevated glucose levels de-
spite using antidiabetic medication. In comparison, only
7.8 % of the diabetic probands, who did not use antidiabet-
ic medication, showed elevated glucose levels. Probands
who had no history of diabetes showed elevated glucose
levels in only 0.2 % (men: 0.3 %, women: 0.1 %).
Elevated blood pressure
Of all probands 36.8 % showed elevated blood pressure,
2.1 % showed severe levels of hypertension (≥ 180 mmHg.
Systolic and/or ≥ 110 mmHg diastolic). The prevalence of
known hypertension increased with age, in men as well as
in women (p  < 0.001). Men showed significantly higher
prevalence of known hypertension than women in all age
groups (Figure 2 panel A).
Of the employees with a history of known arterial hy-
pertension 78.1 % took antihypertensive drugs (Figure 2
panel B). The use of antihypertensive drugs increased con-
tinuously with age.
Interestingly, 63.3 % of the probands who used antihy-
pertensive drugs showed elevated blood pressure levels in
our examination. Of those, 5.2 % even showed severely el-
evated levels. The probands with a history of hypertension,
who did not use antihypertensive drugs, showed elevated
blood pressure levels in 74.3 % of the examinations, 8 %
even showed severely elevated levels (Figure 2 panel D).
The prevalence of unknown hypertension increased con-
tinuously and significantly with age for both sexes (p < 0.001)
(Figure 2 panel C), thus rising up to 59.3 % for men and
50.9 % for women in the group of the 60-to-70-year olds.
Smoking
Overall 23.3 % of the probands indicated to be active smok-
ers. Whereas 25 % of men were former smokers, 51.8 %
had never smoked. In women, 19.9 % were former smok-
ers and 56.8 % had never smoked.
For men and women, the percentage of active smokers
decreased with age (Figure 3 panel A), while the percent-
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 206 M. Scheerbaum et al., Cardiovascular risk factors in Germany

Table I. Baseline characteristics of study population. 27,476 employees met the eligibility criteria and were included.

Characteristics Total Men Women (p-value)

Mean age ± SD, y 42.3 ± 11.8 42.4 ± 11.8 42.2 ± 11.8

Median age, y 43 43 43
Mean height ± SD, cm 174.3 ± 9.4 180.3 ± 7.2 167.4 ± 6.5 p < 0.001
Mean weight ± SD, kg 78.3 ± 16.0 86.2 ± 13.7 69.1 ± 13.5 p < 0.001
Mean BMI ± SD, kg/m2 25.6 ± 4.3 26.5 ± 3.8 24.7 ± 4.6 p < 0.001
Obesity, % 13.8 15.4 12.0 p < 0.001
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Hypercholesterolemia
Total cholesterol ≥ 190 mg/dl, % 50.9 47.1 55.4 p < 0.001
Total cholesterol ≥ 240 mg/dl, % 15.0 13.0 17.4 p < 0.001
Use of lipid lowering drugs, % 2.8 3.6 1.9 p < 0.001
Diabetes/elevated glucose level
History of diabetes, % 2.0 2.4 1.6 p < 0.001
Use of antidiabetic medicine, % 1.3 1.6 0.9 p < 0.001
Elevated glucose level (tested), % 0.5 0.6 0.3 p < 0.001
Blood pressure
History of arterial hypertension, % 16,0 17.8 13.9 p < 0.001
Use of antihypertensive drugs, % 12.5 13.8 10.9 p < 0.001
Elevated blood pressure (tested), % 36.8 42.1 30.7 p < 0.001
Smoking status
Active smoker, % 23.3 23.3 23.3 n. s.
Former smoker, % 22.6 25.0 19.9 p < 0.001

SD: standard deviation; BMI: body mass index.

age of former smokers rose for each age group (Figure 3
panel B).
Correlation and regression analysis
Hypercholesterolemia
Obese employees suffered significantly more often from
hypercholesterolemia than those with regular weight. But
in the regression analysis with sex, age, smoking status,
and elevated blood pressure as covariates, obesity showed
no significant effect on hypercholesterolemia (ESM 1).
Only elevated blood pressure correlated with hypercholes-
terolemia (OR 1.34, 95 %-CI 1.27–1.42, p  < 0.001). When
analysed and stratified for gender, still no significant rela-
tion to hypercholesterolemia could be detected. The effect
of high blood pressure remained (men: OR 1.36, 95 %-CI
1.26–1.47, p < 0.001, women: OR 1.32, 95 %-CI 1.20–1.44,
p < 0.001). In men, former smokers also had a moderately
increased risk (OR 1.14, 95 %-CI 1.04–1.25; p  < 0.01) of
having hypercholesterolemia.
Elevated glucose levels
In total 43.1 % of the probands who had a history of diabe-
tes were obese, while only 13 % of the probands without a
history of diabetes showed signs of obesity (men: 39.4 %
vs. 14.7 %, women: 49.5 % vs. 11.2 %). Meanwhile 6.5 % of
the obese employees had a history diabetes. This is five
times higher than in the non-obese group (1.3 %) (men:
6.2 % vs. 1.7 %, women: 6.8 % vs. 0.9 %).
Sex, age, smoking status, elevated blood pressure as
well as hypercholesterolemia were used as covariates in
the regression analysis. Obesity lead to a threefold in-
creased risk of elevated glucose levels (OR 3.17, 95 %-CI
2.65–3.79, p < 0.001). Probands with elevated blood pres-
sure had a twofold higher risk of elevated glucose levels
than probands without elevated blood pressure (OR 2.19,
95 %-CI 1.77–2.71, p < 0.001).
In obese women, compared to non-obese women, the
risk of elevated glucose level was higher (OR 4.66, 95 %-CI
3.47–6.26, p < 0.001) than in men (OR 2.51, 95 %-CI 2.0–
3.14, p < 0.001). The effect of elevated blood pressure re-
mained (ESM 1).
The regression analysis showed an increased risk of ele-
vated glucose levels for male active smokers (OR 1.43,
95 %-CI 1.07–1.90, p < 0.05) and male former smokers (OR
1.46, 95 %-CI 1.15–1.86, p < 0.01), whereas both active and
former female smokers were associated with a reduced
risk (OR 0.66, 95 %-CI 0.45–0.98, p < 0.05 and OR 0.63,
95 %-CI 0.44–0.92, p < 0.05).

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Figure 1. Upper left (A): means of body mass index (BMI) by gender and age groups (n = 27,476). Upper right (B): means of total cholesterol meas-
ured in mg/dl by gender and age groups (n=27,342). Bottom left (C): use of lipid lowering drugs as proportion (%) by gender and age groups
(n = 27,130). Bottom right (D): history of diabetes as proportion (%) by gender and age groups (n = 27,130).

Elevated blood pressure Discussion

Sex, age, smoking status, hypercholesterolemia, and elevat-
ed glucose levels were the covariates in the regression analy-
sis. Obesity increased the risk of elevated blood pressure
(OR 3.85, 95 %-CI 3.53–4.21, p < 0.001). Obese women (OR
4.36, 95 %-CI 3.81–5.0, p < 0.001) had a fourfold higher risk
of elevated blood pressure than non-obese women. Obese
men had a threefold higher risk of elevated blood pressure
than non-obese men (OR 3.41, 95 %-CI 3.03–3.83, p < 0.001).
Both male and female probands with elevated glucose
levels had a twofold higher risk of having elevated blood
pressure (OR 2.34, 95 %-CI 1.89–2.90, p < 0.001). Moreover,
the risk for elevated blood pressure was increased by hyper-
cholesterolemia (OR 1.28, 95 %-CI 1.21–1.36, p < 0.001).
In our cross-sectional analysis we found that the main risk
factor for a cardiovascular disease, which highly probable
adds to further risk factors, is obesity. The fact that obesity
is one of the main contributors to vascular diseases is not
new knowledge [19–21], but in our survey a BMI above 30
leads to a four times higher risk of elevated blood pressure
and a three times higher risk of elevated glucose levels, thus
summing up cardiovascular risks. In addition to that, for-
mer smokers had a 1.4 times higher risk of being obese than
active or non-smokers. This reconfirms former studies [22,
23]. Furthermore, the rate of obese probands rose with age
reaching almost 20 % in the group of 60 to 70 year-olds.

Obesity
Table II. Proportion of obesity (%) among active, former, and never
Former smokers had a significant higher prevalence of
smokers.
obesity than active smokers and non-smokers (Table II).
This applied for both sexes (p  < 0.001). In the regression Prevalence of obesity by smoking status (n=26,593)
analysis with sex, age, smoking status, elevated blood sug-
Active smoker Former smoker Never-smoker
ar, hypercholesterolemia, and elevated blood pressure as
covariates, former smokers showed a 1.4 times higher risk Total 12.5 % 18.2 % 12.3 %

of obesity (OR 1.41, 95 %-CI 1.28–1.54, p  < 0.001), men: Men 14.5 % 20.5 % 13.1 %
(OR 1.46, 95 %-CI 1.30–1.64, p < 0.001), women: (OR 1.37,
Women 10.2 % 14.9 % 11.5 %
95 %-CI 1.18–1.59, p < 0.001).

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Figure 2. Upper left (A): history of arterial hypertension by gender and age groups (nn = 27,130). Upper right (B): use of antihypertensive medication
among probands with history of hypertension by gender and age groups (n=4,333). Bottom left (C): prevalence of unknown hypertension defined as
significantly elevated blood pressure among probands without history of hypertension or antihypertensive medication by gender and age groups
(nn = 22,514). Bottom right (D): occurrence of severe hypertension among different proband groups (without history of hypertension, with or with-
out antihypertensive medication).

Our analysis further demonstrated a rise of various car-
diovascular risk factors with age. The prevalence of known
diabetes, elevated glucose levels, and known hypertension
as well as elevated blood pressure and hypercholester-
olemia constantly rose with age, confirming former findings
[2, 24, 25]. Only the prevalence of active smokers decreased
with age. Interestingly, the rate of hypercholesterolemia, el-
evated glucose levels, and elevated blood pressure was
higher in those probands who already had a pre-existing
condition of the examined disease. Surprisingly, probands
in treatment for these conditions still showed severely ele-
vated results; thus, raising the questions of compliance and
awareness of those diseases and the effectiveness of their
treatment, a problem which has already been addressed in
former studies [26–29].
Moreover, our regression analysis is showing that ele-
vated glucose levels are more than doubling the risk for
hypertension – thus confirming the associations of diabe-
tes and hypertension in former studies [30, 31]. Surpris-
ingly, in our regression analysis obesity did not lead to ele-
vated levels of cholesterol. Cholesterol seems to be the
sole risk factor with no affection towards obesity among
employees. This seems contrary to former findings [32].
However, elevated cholesterol levels seemed to be associ-
ated to elevated blood pressure, which already has been
published [33], and former smoking men.
Limitations in our sample with over 27,000 datasets can
be found in the non-randomized sampling of companies as
well as the voluntary participation in the offered screen-
ing. Furthermore, only companies who already have a
health sensitive management conducted screening oppor-
tunities in their companies. In addition, there is a risk of
selection and channelling bias, since health-conscious
probands were more likely to take part in such screenings.
On the other hand, our dataset included many big compa-
nies with a wide spectrum of working people, different de-
partments of diverse branches, and different employees
with variances concerning the educational level, social sta-
tus, etc. We further tried to reduce our data limitation by
distinguishing age and gender using the official micro cen-
sus data of the Federal Statistical Office of Germany.
Our main result, which should be discussed, is the heavy
triggering of other cardiovascular risk factors by obesity.
This question has also been raised by Zalesin et al. [8] and
Mandviwala et al. [20]. In our opinion, it is difficult to de-
termine whether obesity can be regarded as a single cardi-

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Figure 3. History of active (panel A) and former (panel B) smoking by gender and age groups (n=26,593).
ovascular risk factor for the development of arterioscle-
rosis or wheter it should be regarded as a sole trigger for
other established cardiovascular risk factors. This also ap-
plies for other pathophysiologically established cardiovas-
cular risk factors, if we regard obesity itself as sole trigger.
Especially, since we were able show that elevated glucose
levels as well as elevated blood pressure could three to four
times more often be found in obese probands than in non-
obese ones. In contrast to former studies, our investigation
could not significantly link obesity to hypercholester-
olemia [32]. In addition to that, the factor of former smok-
ing men as a risk enhancer for higher cholesterol levels has
not been proven so far. This seems troubling since smok-
ing cessation has been the number one prevention aim
over the last decades [34, 35]. Due to these differing re-
sults, further investigations seem necessary.
Furthermore, obesity is one of the few cardiovascular
risk factors that can be influenced by the patients them-
selves. Especially, with the knowledge, that the rate of obe-
sity tripled in the group of the adolescents from 11–17 years
within the last decade in Germany [7], a rise of health costs
in the coming decades seems inevitable. A lower life expec-
tancy within the next century as described for the US [25]
appears also highly likely. Prevention seems to be the most
suitable and cost effective way to keep this problem under
control for future generations. Programs for young adoles-
cents have been reported to show promising results [36].
Also, the effort of the US Centers for Disease Control and
Prevention to fight obesity via a multi-sectional approach
seems promising [9] and should also be adapted to a Ger-
man setting. There is also a certain urgency to these meas-
ures, as a wave of more obese and younger patients can be
expected in the near future since the prevalence of these
conditions is continuously rising in Germany [37, 38].
Conclusions
Whether obesity can be regarded as a solitary cardiovas-
cular risk factor or, whether it should be solely considered
as a trigger for other cardiovascular risk factors, is still
© 2017 Hogrefe
209
unknown. Nonetheless, we regard obesity as the number
one target that can be assessed by various medical, legis-
lative, and socio-economic actions to reduce the cardio-
vascular risk profile of the population and to limit mortal-
ity and health care costs in Germany in the future. For
one, the efforts made by the US CDC should also be incor-
porated into a German prevention plan. Furthermore, the
general practicing colleagues in the field, who deal with
the entire variety of the German population should raise
their awareness of treating and guiding younger patients
with severe overweight for cardiovascular diseases on a
daily basis.
Electronic supplementary material
The electronic supplementary material is available with
the online version of the article at http://dx.doi.org/10.
1024/0301-1526/a000611.
ESM 1. Table. Regression analysis of risk factors. The table
reads as follows: In bold letters we present the tested val-
ue. Underneath each sub header a precondition which in-
fluences the bold written condition is indicated. The influ-
ence is indicated by total numbers as well as by sex for
each sub header.
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Submitted: 08.11.2016
Accepted after revision: 16.12.2016
There are no conflicts of interest existing.
Published online: 03.02.2017
Correspondence address
Dr. med. Christian-Alexander Behrendt
Department of Vascular Medicine
University Heart Center Hamburg
University Medical Center Hamburg-Eppendorf
Martinistraße 52
20246 Hamburg
Germany
ch.behrendt@uke.de
© 2017 Hogrefe