A Surprising Outcome for Obese Patients

Robert W. Griffith, MD

Swiss cardiologists, reporting in the European Heart Journal, describe the 3-year outcome in patients after their procedures to treat unstable angina or one type of heart attack ( non-ST elevation on EKG). They all had coronary angiography, followed where possible by either stent placement or coronary artery bypass.

There were 1676 patients, who were classified according to their body mass index (BMI) as normal (below 25), overweight (25-300, obese (30-35) or very obese (over 35). The 3-year mortality rates were 9.9%, 7.7%, 3.6%, and zero for these 4 classes of patients, respectively.

Obesity is normally associated with diabetes and advanced coronary heart disease. But the results here show that obesity was linked to less than half the risk of death during the 3 years after coronary procedures. This result held up even after adjusting for differences in age, blood pressure, and presence of diabetes; and the angiographic extent of coronary disease was similar in all 4 BMI classes.

What's the reason? The investigators have no definitive explanation, but suggest that obese patients have more detectable and modifiable risk factors for high cholesterol, diabetes, and high blood pressure, and may have undertaken more rigorous steps (increased exercise, diet, and weight loss) than thinner patients. But it's a weak rationale. More studies are needed to explain this phenomenon, though it can already give obese people a little 'heart' to face future cardiac interventions.

Source
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