Clinical research studyThe Obesity Paradox, Weight Loss, and Coronary Disease
Section snippets
Patients
We retrospectively reviewed the case records of 529 consecutive patients with coronary heart disease (44% percutaneous intervention, 35% bypass surgery, and 30% myocardial infarction; some patients had more than 1 event) who completed a 3-month formal program of CRET between January 2000 and July 2005 to ascertain relevant anthropometric, lipid, clinical, and psychological data as previously described.24, 25, 27, 28, 29, 30, 31, 32, 33, 37 We have previously demonstrated that our patients who
Baseline Characteristics
Baseline data describing patients with low and high BMI are demonstrated in Table 1. At baseline, patients with high BMI averaged to be 4 years younger (P <.0001), and this group had significantly higher levels of percent body fat (P <.0001), triglycerides (P <.001), fasting glucose (P <.01), and prevalence of diabetes (P = .054), and lower levels of high-density lipoprotein (HDL) cholesterol (P <.0001) compared with those with low BMI. Only 5 of the 529 patients were active smokers, including 3
Discussion
This study has several important and practical clinical findings. First, this study confirms the “obesity paradox” for the first time among patients enrolled in formal CRET programs, in that overweight and obese coronary patients by BMI criteria have more adverse baseline coronary risk profile yet have considerably lower overall mortality during follow-up. Second, even when coronary patients were divided by the gold standard percent body fat criteria for obesity, patients with higher baseline
Conclusions
Although an obesity paradox exists, in that coronary heart disease patients with higher BMI or higher percent body fat have lower mortality than those with less obesity, these results support the safety and potential long-term benefits of purposeful weight loss in overweight and obese patients with coronary heart disease.
Acknowledgements
The authors greatly appreciate the excellent medical care and data collection provided by the cardiovascular physicians, exercise physiologists, nurses, and dietitians working with cardiac rehabilitation at Ochsner Medical Center. In addition, Ms. Barbara Siede prepared the figures and Ms. Patricia Taylor prepared and edited the submission.
References (65)
- et al.
Obesity and cardiovascular disease: the Hippocrates paradox?
J Am Coll Cardiol
(2003) - et al.
Obesity and cardiovascular disease—risk factor, paradox, and impact of weight loss
J Am Coll Cardiol
(2009) - et al.
The relationship between obesity and mortality in patients with heart failure
J Am Coll Cardiol
(2001) - et al.
Body composition and prognosis in chronic systolic heart failure—the obesity paradox
Am J Cardiol
(2003) - et al.
Disparate effects of left ventricular geometry and obesity on mortality in patients with preserved left ventricular ejection fraction
Am J Cardiol
(2007) - et al.
Obesity paradox in patients with hypertension and coronary artery disease
Am J Med
(2007) - et al.
Obesity, heart disease, and favorable prognosis—truth or paradox?
Am J Med
(2007) - et al.
Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies
Lancet
(2006) - et al.
The association of differing measures of overweight and obesity with prevalent atherosclerosis
J Am Coll Cardiol
(2007) - et al.
AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for referral to and delivery of cardiac rehabilitation/secondary prevention services: endorsed by the American college of chest physicians, American college of sports medicine, American physical therapy association, Canadian association of cardiac rehabilitation, European association for cardiovascular prevention and rehabilitation, inter-American heart foundation, national association of clinical nurse specialists, preventive cardiovascular nurses association, and the society of thoracic surgeons
J Am Coll Cardiol
(2007)
Determinants of referral to cardiac rehabilitation programs in patients with coronary artery disease: a systematic review
Am Heart J
Clinical evidence for a health benefit from cardiac rehabilitation: an update
Am Heart J
Patients with high baseline exercise capacity benefit from cardiac rehabilitation and exercise training programs
Am Heart J
Effects of cardiac rehabilitation and exercise training on low density lipoprotein cholesterol in patients with hypertriglyceridemia and coronary artery disease
Am J Cardiol
Reduction in C-reactive protein through cardiac rehabilitation and exercise training
J Am Coll Cardiol
Effects of cardiac rehabilitation and exercise training on autonomic regulation in patients with coronary artery disease
Am Heart J
Improvements in blood rheology after cardiac rehabilitation and exercise training in patients with coronary heart disease
Am Heart J
Prevalence of hostility in young coronary patients and effects of cardiac rehabilitation and exercise training
Mayo Clin Proc
Prevalence of anxiety in coronary patients with improvements following cardiac rehabilitation and exercise training
Am J Cardiol
Impact of cardiac rehabilitation on depression and its associated mortality
Am J Med
Effects of cardiac rehabilitation, exercise training, and weight reduction on exercise capacity, coronary risk factors, behavioral characteristics, and quality of life in obese coronary patients
Am J Cardiol
Obesity, weight reduction and survival in heart failure: reply
J Am Coll Cardiol
Understanding the basics of cardiopulmonary exercise testing
Mayo Clin Proc
Body mass, fitness and survival in veteran patients: another obesity paradox?
Am J Med
Obesity and suppressed B-type natriuretic peptide levels in heart failure
J Am Coll Cardiol
The incremental prognostic importance of body fat adjusted peak oxygen consumption in chronic heart failure
J Am Coll Cardiol
AOA Fact Sheets: Obesity in the U.S.
Cardiac rehabilitation and exercise training programs in metabolic syndrome and diabetes
J Cardiopul Rehab
Impact of obesity on the pathogenesis and prognosis of coronary heart disease
J Cardiometab Syndr
Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study
Circulation
The obesity paradox: body mass index and outcomes in patients with heart failure
Arch Intern Med
Obesity and heart failure prognosis: paradox of reverse epidemiology?
Eur Heart J
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Funding: None.
Conflict of Interest: The authors have no conflict of interest regarding this study.
Authorship: This is an original work and all authors meet the criteria for authorship, including acceptance of responsibility for the scientific content of this manuscript. All authors had access to the data and had roles in writing and revising the manuscript.