Obesity paradox seen in people with heart disease

Obesity paradox seen in people with heart disease
Subway riders walk through the turnstiles while leaving the U.S. Open in New York September 4, 2007. The 'obesity paradox' -- an unexpected decrease in illness and death with increasing body weight or BMI, which has been described in people with heart failure and in patients having angioplasty -- exists in people with high blood pressure and diseased heart arteries as well, new study findings show. (Lucas Jackson/Reuters)NEW YORK (Reuters Health) - The "obesity paradox" -- anunexpected decrease in illness and death with increasing bodyweight or BMI, which has been described in people with heartfailure and in patients having angioplasty -- exists in peoplewith high blood pressure and diseased heart arteries as well,new study findings show.
In the study, researchers found that overweight and obeseadults with high blood pressure and coronary artery disease hada lower risk of heart attack, stroke or death, compared withtheir normal-weight counterparts.
The reasons for the apparent protective effect of increasedBMI in these populations "are unclear," note Dr. Seth Uretskyfrom St. Luke's-Roosevelt Hospital in New York City andcolleagues in the American Journal of Medicine.
They investigated the effect of overweight and obesity onheart-related outcomes in 22,576 people with treated high bloodpressure and coronary artery disease who participated in alarge study.
Compared to normal-weight subjects with a BMI between 20and 25, the risk of death, heart attack, or stroke was lower insubjects who were overweight (BMI 25 to 30), and in those withclass I obesity (BMI 30 to 35) and class II-III obesity (BMI 35or greater).
"This 'obesity paradox' occurred in men and women acrossall age groups, even though blood pressure was bettercontrolled in normal-weight patients," the investigators note.
In a commentary, Dr. Carl J. Lavie and colleagues of theOchsner Medical Center, New Orleans caution that while improvedoutcomes appear to be consistently associated with increasedBMI, "one should not conclude that weight reduction isdetrimental in overweight populations."
Results of numerous studies, they point out, clearlysupport the benefits of "purposeful weight reduction" in obesepatients with heart disease, despite the obesity paradox.
"As we continue to investigate the obesity paradox incardiovascular disease ... we should remember the old proverb,"Only one thing is certain - that is nothing is certain," Lavieand colleagues advise.
SOURCE: American Journal of Medicine, October 2007.