Obesity Alone Boosts Heart Disease Risk

Research also finds other risk factors are undertreated

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By Serena Gordon
HealthDay Reporter

TUESDAY, Jan. 10, 2006 (HealthDay News) -- Being overweight or obese in middle age, even if you don't have risk factors such as high blood pressure or high cholesterol, increases the odds that you'll develop heart disease later in life.

And if you're overweight or obese, or have other factors that put you at high risk for heart disease or stroke, chances are you're not getting the treatment you need.

Those are the conclusions of two studies that appear in the Jan. 11 issue of the Journal of the American Medical Association.

"All this screaming about obesity, cholesterol, blood pressure and tobacco that's been bombarding you really is truthful. These are problems that can really impact your life," said Dr. Stephen Siegel, a cardiologist at New York University Medical Center.

"The message for middle-aged people is that, just as you worry about saving for your retirement with 401Ks and Keoghs, you also need to worry about your health retirement, and you need to invest in good health at this stage in order to be able to enjoy retirement," he added.

The first study set out to settle the debate about whether excess weight by itself puts people at greater risk of heart disease. Or does being overweight lead to other heart disease risk factors, such as high cholesterol, diabetes and high blood pressure.

The researchers examined data on 17,643 men and women between the ages of 31 and 64 who were included in the Chicago Heart Association Detection Project in Industry. The researchers divided the study participants into five groups: low risk, moderate risk, intermediate risk, elevated risk and highest risk for heart disease.

Those in the low-risk group didn't smoke, and had normal blood pressure and cholesterol readings. The moderate-risk group also didn't smoke, but may have had either slightly elevated blood pressure or cholesterol. People in the intermediate-risk group had one of the following risk factors: current smoking, high cholesterol or high blood pressure. Those in the elevated-risk group had two of those risk factors, and the highest-risk group had all three.

The researchers also gathered information on the participants' body mass index (BMI), a ratio of weight to height. The average follow-up time was 32 years.

The risk of death from heart disease was 43 percent higher for obese people in the low-risk group compared to people of normal weight. In the moderate-risk group, the risk of death from heart disease was 2.1 times higher for obese people. The risk of hospitalization was also higher for obese people -- in the low-risk group, obese people had a 4.2 times greater risk of hospitalization for heart disease.

"Our study is one more piece of evidence that overweight and obesity do increase health risks, whether or not you have other risk factors. People need to pay attention and maintain a healthy body weight," said study author Lijing Yan, a research assistant professor at the Northwestern University Feinberg School of Medicine in Chicago and an assistant professor at Guanghua School of Management at Peking University in China.

The second study included information on nearly 70,000 people from 44 countries. All of the study participants had established arterial diseases, such as heart disease, stroke or peripheral artery disease. Many of these people were also overweight or obese, according to the researchers.

In these people, who were already at high risk for additional problems, almost 70 percent were undertreated for high cholesterol, nearly 80 percent were undertreated with anti-clotting medications, and 50 percent had undertreated high blood pressure, the study found.

"We found a high rate of undertreatment in this population, most of whom already had a heart attack or stroke. Risk factors weren't optimally controlled. There were far from optimal rates of antiplatelet therapy and statins, and people were still hypertensive at visits," said study author Dr. Deepak Bhatt, a cardiologist at the Cleveland Clinic.

Both Bhatt and Siegel said patient reluctance to take medication may be one of the reasons for undertreatment. Another reason, according to Bhatt, may be the cost of treating these risk factors. It may also be that primary-care physicians, the doctors who were treating most of the people in this study, may not be aware of current guidelines for each specialty.

Bhatt said an electronic system could help with some of these factors. For example, if a patient had high cholesterol, the system would flag that patient and provide the treating physician with the most current guidelines available.

The study also found that 16 percent of people with symptoms of heart disease had other circulatory problems as well. That means that someone who had symptomatic heart disease had about a one in six chance of having another circulatory problem, such as stroke or peripheral artery disease, Bhatt said.

The bottom line, according to Bhatt, is that "physicians across specialties need to be aware of the cross risks their patients face. Cardiologists might not worry about stroke, and likewise, neurologists might not think that their mini-stroke patient is at risk of a heart attack. We need to approach vascular disease as a problem with circulation, period. The entire circulatory system is at risk."

Siegel agreed and said physicians and patients need to think of these circulatory diseases more as one disorder. "It's an artery problem," he said. "We tend not to think of the arteries as an organ, but that's what's failing, and artery problems can affect the heart, the kidneys, the brain and more."

More information

To learn more about the health consequences of being overweight or obese, visit the U.S. Surgeon General.

SOURCES: Deepak Bhatt, M.D., staff cardiologist and associate professor, medicine, The Cleveland Clinic, Ohio; Lijing Yan, Ph.D., M.P.H., research assistant professor, Feinberg School of Medicine, Northwestern University, Chicago, and Guanghua School of Management, Peking University, Bejing, China; Stephen Siegel, M.D., cardiologist, New York University Medical Center, and clinical assistant professor, New York University School of Medicine, New York City; Jan. 11, 2006, Journal of the American Medical Association

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