Item #6

Every Extra Pound Increases Your Risk for Heart FAILURE!

"For every unit increase in BMI there is a 5% increase in risk of heart failure," that according to the ongoing Framingham Heart Study.

Since 1976, participants in this intensive study have given U.S. researchers a look at who does and who doesn't get heart disease. Now the Framingham team finds that risk of heart failure goes up along with one's weight.

Didn't we know this already? Not quite. Earlier studies linked being too fat with heart disease (hardening of the arteries in the heart). To most doctors, this meant that obese people have other risks for heart disease such as high blood pressure or diabetes.

Heart failure is often related to heart disease, but it is different; it's a complex condition in which the heart becomes unable to pump blood properly to the lungs or to the body. People with the condition often experience disabling shortness of breath or swelling of the feet and legs. It usually is caused by heart disease, but the new findings show that being fat -- all by itself -- can cause heart failure.

Being obese is very, very hard on the heart. But just a little extra weight hurts, too. Ramachandran S. Vasan, MD, teaches medicine at Boston University and is co-director of the Framingham echocardiography lab.

"What we find is a continuum of risk."  "There is a continuous spectrum of risk from normal to overweight to obese."

Where are you on this risk spectrum? You first must know your body mass index or BMI. It's a rough way to know how close to normal your weight is for your height. To calculate BMI, divide your weight in kilograms by the square of your height in meters.

A BMI score of 18-24.9 is normal. A score of 25-29.9 means you're overweight. And if your BMI hits 30, you're officially obese. The new findings mean that for every point of BMI over normal, heart-failure risk goes up.

"For every unit increase in BMI there is a 5% increase in risk of heart failure," Vasan says. "Whether you go from 24 to 25 or from 34 to 35, you're still increasing your risk."

By the time a person becomes obese, that increase is 200% -- double the heart-failure risk for a person of normal weight. For women, but not for men, crossing into the "overweight" category increases heart failure risk by 50%.

This study makes the most convincing argument yet that being overweight and being obese are associated with increased risk of heart failures, says Dr. Massie,  chief of cardiology at the San Francisco Veterans Affairs Medical Center and professor of medicine at the University of California, San Francisco. The findings are important: Despite recent advantages in treating heart failure, the condition continues to cause severe illness, disability, and carries a significant risk of death.

"It certainly is a message to lose weight," Vasan says. "People need to know their BMI and need to discuss it with a doctor. If they are overweight or obese, they need to discuss heart-failure risk factors, diet, and goals for physical activity. We want them to move into the normal weight category."

Why does extra weight hurt the heart? Vasan points to animal studies suggesting that too much body fat is toxic to the heart's muscle cells. He also notes human studies showing that obese people's hearts undergo physical changes that could promote heart failure.

Massie suggests that the culprit may be a condition called metabolic syndrome. That's a cluster of obesity-related findings -- centered on problems with fat metabolism -- that means a person is on the way to developing diabetes and heart disease.

Nothing works better for preventing all forms of heart disease and diabetes than what doctors call "lifestyle modification." This means eating less and exercising more. But not everyone succeeds at this. For these people -- and for those who may suffer lingering effects from having once been obese -- drug treatments may help.

Massie says it's important for scientists to study whether it might be possible to lower the risk of heart failure in obese people by treating them before they develop any other symptoms. Treatments that might be especially good to study, he suggests, are the anti-diabetes drug Glucophage and heart-friendly, blood-pressure-lowering drugs such as ACE inhibitors.  Massie's commentary article accompanies the Vasan team's study in the Aug. 1 issue of The New England Journal of Medicine.