Obese Have Higher Cardiac Risk, but Better Treatment Outcomes

Obese individuals are at increased risk for developing an acute coronary syndrome (ACS), but because they are treated more aggressively than their lean counterparts, their outcomes are actually better. 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, lead author Dr. Deborah B. Diercks, from the University of California Davis Medical Center in Sacramento, and colleagues note.

To investigate, the researchers analyzed data from over 80,000 patients with high-risk non-ST-segment elevation ACS who participated in the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines (CRUSADE) initiative. Standard BMI-based classifications of weight were employed.

Roughly 71% of patients were overweight or obese, the report indicates. Compared with normal-weight individuals, these subjects were younger and more likely to have comorbid conditions, such as diabetes, hypertension, and hyperlipidemia.
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% less likely to die or experience recurrent MI than were normal weight patients. By contrast, underweight patients were 20% more likely to die than normal weight patients and there was a trend toward increased mortality in extremely obese patients.

Am Heart J 2006;152:140-148.

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