A New Paradox: Weight and Short-Term Outcomes

Although obesity is a known risk factor for cardiac disease, several recent studies have found that obesity does not seem to be an indicator of premature death.

For the past several decades, obesity has been identified as a risk factor for cardiac disease: heart failure (HF), acute coronary syndrome (ACS), and coronary artery disease (CAD). Although we have assumed that obesity would decrease survival after a cardiac event, several studies have found that some patients seem unaffected by their obesity when it comes to survival. A few recent studies found that a high body mass index or large waist circumference was inversely associated or unassociated with mortality outcomes in patients with advanced HF, ACS, and CAD.

It’s paradox. How can obesity be a risk factor for cardiac disease, yet not contribute to premature mortality?

Cardiac disease is now considered epidemic in the Arab Gulf region. Researchers used the Gulf registry of acute coronary events that covers 6 Arab Gulf countries (Bahrain, Saudi Arabia, Qatar, Oman, United Arab Emirates, and Yemen) to determine if obesity is associated with mortality in this population.

This study was large (n = 4379). Obesity was neither associated with in-hospital and peri-hospital mortality nor protective for it. It had no effect. The researchers confirmed that overweight and especially obesity were risk factors for cardiovascular diseases and death in this population. After the disease developed and an acute event occurred, however, obesity had only modest effects on patients’ short-term course and outcomes.

The authors indicate, “…physicians should not be overly concerned about the body size or composition of their patients with ACS, but after patients recover from acute disease, management of obesity might be considered as an integral part of tertiary prevention.”

Interestingly, the researchers found that a history of dyslipidemia was protective. They suggest that most patients with a history of dyslipidemia are treated with statins, and it is the drug therapy that is actually protective and improves prognosis after acute disease occurs.

Among their other findings were that age, female gender, diagnosis of ST-elevation myocardial infarction, and history of HF significantly increased risk for in-hospital and peri-hospital mortality among patients with ACS.

Ms. Wick is a visiting professor at the University of Connecticut School of Pharmacy and a freelance writer from Virginia.