Many prospective studies show that obesity is accompanied by increased risk for cardiovascular disease. Obesity affects metabolism of lipids and glucose, regulation of blood pressure, thrombotic and fibrinolytic processes, and inflammatory reactions. Multiple aberrations exist in each of these systems; obesity acting alone probably is not sufficient to produce full-blown metabolic syndrome. There must be other factors, including genetic and aging factors. It is difficult to sort out all pathogenic factors that link obesity to cardiovascular disease risk. It is worthwhile to investigate individually the components of the obesity-induced metabolic syndrome for their atherogenic potential, because out of that investigation likely will come new targets for clinical or public health intervention to reduce the risk for cardiovascular disease.