Overweight men at higher risk of heart attack, stroke, premature death

Dec 28, 2009

(PhysOrg.com) -- Overweight or obese middle-aged men are at a higher risk of heart attack, stroke and premature death — even if they don’t have the metabolic syndrome, according to research reported in Circulation: Journal of the American Heart Association.

“Previous studies have put forward the existence of a “metabolically healthy” subgroup of who are at no increased cardiovascular risk, but if you follow them long enough, you find out there appears to be no such thing as metabolically healthy obesity,” said Johan Ärnlöv, M.D., Ph.D., associate professor of cardiovascular epidemiology at Uppsala University in Uppsala, Sweden.

When previous studies have examined the occurrence of heart disease risk with obesity and the metabolic syndrome (MetS) — a cluster of risk factors associated with the development of heart disease and diabetes — obese people without MetS have not portrayed an increased risk. However, these studies followed people for 13 years or less and it is possible that the increase in risk in the obese without the MetS becomes more evident after 10 - 15 years, Ärnlöv said.

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The current 30-year study involved 1,758 born between 1920 and 1924 in Uppsala. Each underwent a health evaluation at age 50, and those who had diabetes or had been hospitalized for heart disease were not included.

During the follow-up, 681 suffered a cardiovascular event (death or hospitalization from , or heart failure) - including 386 cardiovascular deaths. After adjusting for age, smoking and the men’s levels of “bad” LDL-cholesterol, the researchers compared men with MetS and/or high body mass index (BMI) with those of normal weight and without MetS. The researchers found that the risk of cardiovascular disease was:

• 63 percent higher in normal weight men with MetS;
• 52 percent higher in overweight men without MetS;
• 74 percent higher in overweight men with MetS;
• 95 percent higher in obese men without MetS;
• 155 percent higher in obese men with MetS.

“Normal weight men with the metabolic syndrome were at increased risk, and overweight and obese men were at increased risk even if they did not have the metabolic syndrome,” Ärnlöv said.

“Doctors need to address a person’s total risk, including smoking, cholesterol, blood pressure and weight. Some researchers have suggested that a heavy person without other risk factors didn’t need to lose weight, but our data does not support this notion.”

Researchers classified men as having the metabolic syndrome if they had three or more of these findings at the time of their original exam:

• impaired ability to handle glucose [fasting blood glucose at least 110 milligrams per deciliter (mg/dL)];
• elevated blood pressure (at least 130/85mm Hg or being treated with medication);
• high levels of the blood fats called triglycerides (at least 150 mg/dL);
• low levels of “good” HDL cholesterol (less than 40 mg/dL);
• BMI at least 29.4 kg/m2. A large waist, indicating excessive fat tissue around the abdomen, is usually used in assessing the metabolic syndrome but was not available for this group of men.

Long-term data on these factors is not available for women, but Ärnlöv said doctors should pay attention to women’s weight as well as their other cardiovascular risk factors.

“I don’t think we should consider obesity without the MetS to be benign in women just because we don’t have the data yet,” Ärnlöv said.

The results were not surprising, according to an American Heart Association spokesperson.

“We’ve known for years that worsens or exacerbates many risk factors,” said Barry Franklin, Ph.D, chair of the American Association’s council on Nutrition, Physical Activity and Metabolism. “What was interesting about this study was that the findings differed from previous studies - which involve much shorter follow up - that suggested that obese people without were not at risk. This study really contradicts that and I believe it’s in large part related to longer follow up.”

Franklin said the role of fitness in reducing cardiovascular disease was not discussed in this study. As New Year’s resolutions approach he urged patients to recognize that even a five to pound weight loss can make a significant health benefit.

Explore further: NAMS issues first comprehensive recommendations on care of women at menopause and beyond

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