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Amanda Jekowsky , American College of
Cardiology, 202-375-6645, ajekowsk@acc.org
May
18, 2009
Heart Disease Patients Carrying Extra Pounds Do Better, Live
Longer
Weight of Evidence Still Points to Purposeful
Weight Loss, Further Research Needed
Being overweight or obese is a leading contributor to cardiovascular
disease (CVD) and associated risk factors; however, in patients
with established CVD, obesity appears to play a protective
role. In fact, data suggest obese patients with heart disease
do better and tend to live longer than leaner patients with
the same severity of disease, according to a review article
published in the May 26, 2009, issue of the Journal of
the American College of Cardiology.
“Obese patients with heart disease respond well to
treatment and have paradoxically better outcomes and survival
than thinner patients,” said Carl Lavie, M.D., F.A.C.C.,
medical director of Cardiac Rehabilitation and Prevention,
Ochsner Medical Center, New Orleans, LA and lead author of
the article. “Although these patients have a more favorable
short- and long-term prognosis, we don’t yet understand
the mechanisms for why this might be the case.”
The obesity paradox in patients with CVD, which was first
noticed earlier this decade, is complex. It is likely due
to a combination of obesity’s impact on fat cells and
other metabolic processes (e.g., insulin resistance, glucose
metabolism, metabolic syndrome), as well as other consequences
of being obese. Dr. Lavie speculates that excess weight may
be somewhat protective because these patients have more reserves
to fight disease than thinner patients. Another explanation
might be that obese patients present with problems earlier
due to physical deconditioning (being out of shape) and other
non-cardiovascular symptoms and, therefore, have the opportunity
to be diagnosed with milder disease.
Although obese patients appear to experience fewer cardiovascular
events and have better survival rates, Dr. Lavie is quick
to caution that patients with heart disease shouldn’t
incorrectly assume that gaining weight is the answer.
“Obesity is often what’s causing high blood pressure,
blockages in arteries, and increased risk of sudden death
in the first place. Such excess weight has adverse effects
on all of the major cardiovascular risk factors and has increased
the prevalence of heart disease,” he said. “Taken
together, most studies are supportive of purposeful weight
loss for preventing and treating cardiovascular disease.”\
Health-promoting behaviors to stay active and lose weight
can also confer benefits beyond initial heart disease. For
example, patients who are overweight or obese are at heightened
risk of diabetes, which can further complicate treatment and
outcomes. Patients who make sustained lifestyle changes, including
regular exercise and some weight reduction through a reduction
in calories, cut their risk of developing diabetes by roughly
60 percent.
“Obesity is skyrocketing in America and if this continues,
we may see an unfortunate reversal to what has been a steady
increase in life expectancy,” says Dr. Lavie. “We
need more research: first to prevent obesity in the first
place; second, to intervene early enough so that patients
who are overweight or obese won’t develop heart disease;
and then to better understand why these patients have a better
prognosis once they have heart disease. Perhaps this information
could lead to benefits for all patients, including patients
with heart disease who aren‘t overweight or obese.”
According to authors, obesity may soon overtake tobacco use
as the leading cause of preventable death in the United States
if current trends continue. Nearly 7 out of 10 adults are
classified as overweight or obese. In adults, overweight is
defined as a body mass index (BMI) 25 to 29.9 kg/m2 and obesity
as BMI =30 kg/m2. Other indices that have been used less commonly,
but possibly with more predictive power include body fatness,
waist circumference (WC), waist-to-hip ratio (WHR), and weight-to-height
ratio.
“Clinicians should emphasize to patients the importance
of achieving and maintaining a healthy weight, as well as
benefits that can be obtained from restricting their intake
of calories and getting regular exercise of 30 to 40 minutes
on most, if not all, days,” said Dr. Lavie.
He and his co-authors report no conflicts of interest.
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The American College of Cardiology is leading the way to optimal
cardiovascular care and disease prevention. The College is
a 36,000-member nonprofit medical society and bestows the
credential Fellow of the American College of Cardiology upon
physicians who meet its stringent qualifications. The College
is a leader in the formulation of health policy, standards
and guidelines, and is a staunch supporter of cardiovascular
research. The ACC provides professional education and operates
national registries for the measurement and improvement of
quality care. More information about the association is available
online at www.acc.org .
The American College of Cardiology (ACC) provides these news
reports of clinical studies published in the Journal of
the American College of Cardiology as a service to physicians,
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statements or opinions expressed in these reports reflect
the view of the author(s) and do not represent official policy
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