Features March 2010 Issue

There’s No Such Thing as Overweight and Heart Healthy

Research shows that carrying extra pounds, even with normal blood pressure and cholesterol levels, can pose a cardiac risk.

There has long been an idea that if a person is overweight, but has other cardiovascular risk factors in check, the heart disease risk is low. However, recent research says that obesity or even being overweight is enough to put a person at risk even if other risk factors are not present.

The study, published in the December issue of Circulation: Journal of the American Heart Association, contradicts some longheld notions about heart risk and should be a wakeup call for anyone who believes obesity alone canít put them at risk of a heart attack or stroke, according to Leslie Cho, MD, director of Preventive Cardiology and Rehabilitation at Cleveland Clinic and the physician editor of Heart Advisor.

"I think there is no magic number where weight is concerned, however most people that what you weighed in high school may be you ideal weight," Dr. Cho says. "Another good measure is waist circumference, less than 40 inches for a man, and less than 35 inches for a woman."

She adds that a waist-to-hip ratio of less than 0.8 and a body mass index (BMI) of less than 25 are other good indicators.

BMI is a relationship between a personís height and weight that is associated with body fat and health risks. A BMI of 25 to 29.9 is considered overweight, while a BMI of 30 and above is considered obese. There are many BMI calculators on the Internet, but to do it on your own, multiply your weight by 703 and divide that number by your height in inches squared.

The Circulation study involved more than 1,700 men born between 1920 and 1924. For 30 years, the study participantsí health was monitored regularly. The results showed that, for example, the risk of cardiovascular disease (CVD) was 74 percent higher in overweight men with metabolic syndrome (MetS) and 95 percent higher in obese men without MetS. Not surprisingly, the CVD risk of obese men with MetS was 155 percent higher.

Simplifying Metabolic Syndrome

While the numbers and terms that compose metabolic syndrome may be difficult to keep track of, Dr. Cho urges those who may be at risk to focus on some easy-to-remember indicators.

"There has been some confusion about what defines metabolic syndrome," she explains. "But if you have hypertension, high cholesterol and increased weight, you might have metabolic syndrome, which is a precursor for diabetes. Having metabolic syndrome increases your risk for major adverse cardiac events, so itís especially important to control your weight and your other risk factors."

Interestingly, the Circulation study also found that the risk of CVD was 63 percent higher in normal-weight men with MetS and 52 percent greater in overweight men without MetS. The researchers said physicians and patients need to focus on all risk factors, including those such as smoking and a sedentary lifestyle.

Dr. Cho again says the keys to managing your risk factors are simple, well-established behaviors. To help control blood pressure, for example, Dr. Cho recommends weight loss, regular exercise, a healthy diet, reduced salt intake, reduced stress and regular monitoring of your blood pressure to know how it may be trending.

For those with abnormal cholesterol, the advice is much the same, but be especially mindful of ingredients such as trans fats that can raise levels of LDL ("bad" cholesterol) levels and contribute to coronary artery disease.

"There are medications out there that can help you," Dr. Cho notes. "However, medications are not a substitute for a healthy lifestyle. They are merely supplements to a healthy lifestyle."

For Those With diabetes

She adds that for patients with diabetes, coronary artery disease or chronic renal disease, their blood pressure should be less than 130/80 if possible, and certainly less than 140/90.

"Ideally, it should be around 120/70," Dr. Cho says. "An important thing to remember is to take your medication. Many patients start medication, but their blood pressure is never controlled because they stop taking their medication due to side effects. There are so many medications out there that your doctor can help you find something that works for you."

Medication adherence, as well as weight loss, exercise and a healthy diet also are crucial if you have insulin resistance.

The Final Word

Weight loss has benefits beyond reduced cardiac risk factors. Obesity can increase your odds of developing several types of cancer, along with just sapping your energy, interfering with quality sleep and so forth.

Your healthcare providers know that shedding pounds can be difficult.

"Losing weight is one of the hardest things in the world," Dr. Cho. "However, there are programs out there that can help you. Also, we find that many of our patients are on medications that can increase weight. You should talk to your doctors about finding a medication that is more weight-neutral."

She adds, however, that the responsibility starts and ends with the patient.

"It really is up to the patient," she says. "We canít force patients to become healthy. They have to take ownership of their body. Once they do, we can give them information and all the help, like a nutritionist and exercise physiologist, to assist them."