Obese have higher heart risk, but better outcome

NEW YORK (Reuters Health) - Obese individuals are at increased risk for suffering a heart attack or other "acute coronary syndrome" (ACS), but because they are treated more aggressively than their lean counterparts, their outcomes are actually better, new research suggests.

However, being extremely obese or underweight increases the cardiac mortality risk.

Numerous reports have identified obesity as a risk factor for coronary artery disease, but its influence, if any, on the presentation, treatment, and outcome of ACS was unclear, Dr. Deborah B. Diercks, from the University of California Davis Medical Center in Sacramento, and colleagues note.

To investigate, they analyzed data from over 80,000 patients with high-risk ACS who participated in a heart trial. Roughly 71 percent of patients were overweight or obese.

Compared with normal-weight individuals, overweight or obese subjects were younger and more likely to have comorbid conditions, such as diabetes, hypertension, and elevated lipid levels.

Overweight and obese patients were more likely than normal-weight patients to receive guideline-recommended medications within the first 24 hours of presentation and to undergo invasive cardiac procedures.

After adjusting for age and other factors, overweight and mildly obese patients were about 11 percent less likely to die or experience recurrent MI than were normal weight patients.

By contrast, underweight patients were 20 percent more likely to die than normal weight patients and there was a trend toward increased mortality in extremely obese patients.

Further studies, the team concludes, are needed to determine how variations in hospital management of patients by weight "contribute to the risk of adverse outcomes."

SOURCE: American Heart Journal July 2006.