Women's Heart Advisor January 2016 Issue

Overweight Women with Heart Failure Have Better Chances

Overweight, but not obese, women with heart failure live longer.

The average woman is all-to-familiar with weight creep, a phenomenon that causes extra pounds to magically appear after menopause. As frustrating as this may be, new research suggests that a few unwanted pounds may help women—but not men—with heart failure live longer.

“The biological basis for this relationship between body mass index and mortality, and the role of gender in this relationship, is only partially understood,” says Leslie Cho, MD, Director of the Women’s Heart Center at Cleveland Clinic and principal author of a paper on the so-called overweight/obesity paradox published in the November 2105 JACC: Heart Failure.

Before we go any further, let’s address the obvious question: Does this mean being overweight is safe, or even desirable?

“Absolutely not,” says Dr. Cho. “If a woman is slightly overweight, it may not be so urgent for her to lose weight. However, obesity is a key factor in heart health, and we continue to emphasize that maintaining a healthy weight is important.”

Explaining the unexplained

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The association between extra weight and equal or improved survival in heart failure patients has been known for years. Several theories have attempted to explain the connection, but none has been confirmed.

Recently, a basic science finding that women’s hearts utilize more fatty acids and less glucose than men’s hearts grabbed Dr. Cho’s attention. After all, women with heart failure tend to live longer than their male counterparts. She wondered if excess fatty tissue was providing that benefit.

“We simply wanted to test the hypothesis. We also wondered if the obesity paradox might be true for both men and women alike.”

The overweight survival paradox

Dr. Cho and colleagues looked at 3,800 patients of both sexes with heart failure who had undergone cardiopulmonary testing between 1995 and 2011 and noted their weight categories (normal, overweight or obese) at the time of death. They found overweight women lived the longest, followed by obese women and women of normal weight. All men fared less well, with overweight and obese men having the shortest lifespan.

“It’s extremely important for men with heart failure to keep a healthy body weight,” says Dr. Cho.

So what does all this mean?

“There are differences between women’s and men’s hearts,” says Dr. Cho. “The fact that the overweight survival paradox applies only to women merits further investigation.

“Understanding why a modest amount of excess fatty tissue has a more favorable impact on women may reveal new treatment opportunities in advanced heart failure and help us know how to counsel heart-failure patients regarding weight management," she says.

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