Obese Patients Less Likely to Die After Heart Attack

Researchers at Herz-Zentrum Bad Krozingen, Germany have found what can best be described as a health paradox; people who are obese face half the risk of death following a heart attack in comparison to people with normal weight.

The conclusion was arrived at after a study of nearly 1,700 heart attack patients. All the patients had been hospitalised and received treatment for unstable angina/non-ST-segment elevation, a common type of heart attack. Dr. Heinz Joachim Buettner, head of Interventional Cardiology at Herz-Zentrum Bad Krozingen and colleagues analysed the health outcomes for the patients over a three year follow-up period.

50% of the study patients were obese, another 18% were either obese or very obese while about a third of the patients were normal weight. The researchers observed that the obese and very obese patients were comparatively younger than the normal weight patients. They were also more likely to have high blood pressure and diabetes.

Majority of the patients had been admitted for their first heart attack. As a result the possibility of their being prescribed heart medications such as statins, ACE-inhibitors and beta-blockers at the time of leaving the hospital was also high.

During the follow-up period, the researchers found that obese and very obese patients were at less than half the risk of dying compared to patients with normal weight. Overall death rates were 9.9% for normal-weight patients and 7.7% for overweight patients. The death rate for obese patients on the other hand was only 3.6% while none of the very obese patients died.

“Once a heart attack has occurred and been optimally treated, obese patients switch to a more favorable prognosis compared to normal-weight patients,” said Dr. Buettner about their study findings published in the European Heart Journal. The researchers however warned that their findings should not be interpreted as a license for people to start stuffing themselves because obesity is notoriously well known for being a major cause of heart attacks.

“Every effort should continue to prevent and treat obesity, and this study should not be taken to mean that it is good for one’s health to be overweight or obese,” said Dr. Gregg C. Fonarow, Director of the Ahmanson-UCLA Cardiomyopathy Center at the University of California, Los Angeles.

Researchers are not clear as to why this paradox exists; however Dr. Fonarow opines it might be on account of obese people having more biological resources to draw upon than normal-weight people. “Patients who are overweight and obese may be able to draw on greater metabolic reserve than patients who are in the underweight or healthy weight categories,” he said.

“We have previously published on an obesity paradox in patients with acute as well as chronic heart failure, so this paradox applies to a number of cardiovascular disease states,” Dr. Fonarow added.

At the same time, Dr. Buettner stressed on the importance of keeping fit and thereby lowering the risk of having a heart attack in the first place. “It is well known that even a modest intentional weight loss can improve or prevent obesity-related cardiovascular risk factors like diabetes mellitus and arterial hypertension,” he said. This means that “obese people have a great potential to influence their prognosis, and they should start the effort before an acute coronary event occurs,” Dr. Buettner added.

Agreeing to Dr. Buettner’s advice, Dr. Fonarow stated that putting on too much weight is not the answer to preventing a heart attack or shielding yourself from death after one. “The findings from this study further confirm the findings of a number of prior studies that demonstrated an obesity paradox exists in patients with established cardiovascular disease, including those presenting with acute coronary syndromes receiving therapy,” he said.

“However, even though obese patients with acute coronary syndrome had a lower risk of post-heart attack death, obesity strongly contributes to an increased risk of heart trouble, diabetes, and cardiovascular death,” Dr. Fonarow added.

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