Context: The worldwide epidemic of overweight and obesity is setting the scene for a new wave of premature cardiovascular disease (CVD).

Objective: To define relationships between dyslipidemia and other metabolic abnormalities in overweight subjects.

Design: Comparison of overweight subjects with and without dyslipidemia

Setting: Institutional practice

Patients: Dyslipidemic subjects (n=715) had plasma triglyceride 75^th percentile in combination with HDL-C 25^th percentile. Unrelated, normolipidemic controls (n=1073) had HDL-C higher than the median and triglyceride lower than the median. It was a requirement for the control subjects to have a BMI greater than 25 kg/m².

Main Outcome Measures: BMI, inflammatory markers, adipokines, blood pressure and fasting plasma glucose and insulin.

Results: The mean BMI in the cases and controls was 28.7 and 28.2 kg/m2, respectively. Cases had higher levels of plasma hs-CRP (3.0 vs 2.0 mg/L, p<0.001), lower levels of adiponectin (4.7 vs 6.6 mg/L, p<0.001) and, after adjustment for age, BMI, gender, smoking, statin and beta-blocker use, higher systolic (p=0.001) and diastolic (p=0.05) blood pressures. Fasting plasma glucose, insulin and homa-IR were all significantly higher in cases than controls (p<0.0001).

Conclusions: Identification of people solely on the basis of an elevated plasma triglyceride and a low HDL-C uncovers an overweight group of people who have a generalized metabolic disorder. In contrast, overweight people with normal plasma lipids have normal glucose and insulin metabolism, low levels of inflammatory markers and normal blood pressure. Such people may thus be at relatively low risk of developing diabetes and cardiovascular disease despite being overweight.