Prognosis worse in obese heart patients

Obesity - especially abdominal obesity - is associated with a poor outlook for patients with established cardiovascular disease, results of a recent study indicate.

Higher body mass index (BMI), a height to weight ratio used to determine obesity, and the presence of abdominal fat increases the risk of developing cardiovascular disease, but whether they each independently predict the outcome of people who already have cardiovascular disease has not been well defined, Dr. Gilles R. Dagenais, of Laval University Heart and Lung Institute, in Quebec, and colleagues report in the American Heart Journal.

The researchers examined the impact of increased BMI, waist-to-hip ratio and waist circumference on the occurrence of cardiovascular disease death, heart attack, stroke, heart failure, and death from any cause among patients with cardiovascular disease enrolled in the Heart Outcomes Prevention Evaluation study.

The analysis included 6620 men and 2182 women followed for an average of 4.5 years. During follow-up, there were 1034 deaths, of which 658 were due to cardiovascular disease.

In addition, 1018 subjects had a heart attack, 364 had a stroke, and 297 had a congestive heart failure episode.

Compared with subject with the lowest BMI, those with the highest had a significant 20-percent increase in the risk of heart attack.

The risk for patients with the highest waist circumference was increased by 23 percent for heart attack, 38 percent for heart failure, and 17 percent for total death rate.

Subjects with the highest waist-to-hip ratio had an increased risk of 24 percent for cardiovascular disease death, 20 percent for heart attack and 32 percent for total death rate.

"Weight reduction should be integrated in the active management of these patients," Dagenais and colleagues conclude. "However, the impact of this management on the prognosis of these patients awaits further evaluations."

SOURCE: American Heart Journal, January 2005.

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