Obese people may get better heart disease therapy

By Will Boggs, MD

NEW YORK (Reuters Health) - Overweight and obese patients with heart disease seem to be treated more aggressively than their leaner counterparts, which may, in part, explain why they are less likely to die during their hospital stay, new research shows.

Previous research has identified a so-called obesity paradox. Although patients who are overweight or obese are more prone to developing heart disease, once they have it, they often fare better than people of normal weight.

"Part of the message here is that we should not make treatments differ by body mass index (BMI)," Dr. Christopher P. Cannon told Reuters Health.

Body mass index is a measure of person's body weight for height. BMI values of 20 to 25 are considered normal, while higher values indicate overweight or obese status and lower values indicate underweight status.

As reported in the American Journal of Cardiology, Cannon from Brigham and Women's Hospital in Boston, and colleagues stratified more than 130,000 patients hospitalized for heart disease by BMI and assessed treatments received and outcomes.

Obese and overweight patients were younger, more likely to be male, have high blood pressure, high cholesterol, and diabetes than were patients with lower BMI.

Nonetheless, overweight and obese patients were less likely to die while hospitalized and had a shorter hospital stay than did patients with a normal BMI.

The difference in death rates may lie with the treatments each group received. Overweight and obese patients were more likely and underweight patients less likely to undergo aggressive, potentially life-saving treatments like angioplasty or bypass surgery than healthy weight patients, the authors report.

"Sometimes BMI might influence what we do -- but we would like to take it out of our treatment algorithms and try to improve care for all patients," Cannon said.

"Regardless of the reasons for inconsistencies in treatment rates, physicians need to be aware that patients with increased body mass remain at high risk for development of (heart disease)," he and his colleagues conclude.

"Although they were more likely to survive their acute events, overweight patients were more likely to develop them at a younger age, thus increasing their risk for poor outcomes over the long term."

SOURCE: American Journal of Cardiology, November 1, 2007.