European Heart Journal Advance Access originally published online on October 24, 2007
European Heart Journal 2007 28(23):2950; doi:10.1093/eurheartj/ehm460
Effects of obesity on mortality in patients with unstable angina or non-ST-elevation myocardial infarction
Department of Internal Medicine
University Hospital Zurich
Ramistrasse 100
Zurich 8091
Switzerland
Cardiovascular Department
Division of Angiology
University Hospital Berne
Berne 3010
Switzerland
Tel: +41 442555663 Fax: +41 442558747 E-mail address: barton{at}usz.ch
In a recent article, Buettner et al.1 proposed that obesity is associated with improved outcome in coronary artery disease patients after early revascularization because of UA/NSTEMI over a mean follow-up time of 17 months. The data presented in the first figure suggest that severity of obesity is inversely related to cumulative 3-year cardiovascular mortality. Although one would wish that—in addition to its known deleterious metabolic effects and the accelerated development of atherosclerosis2,3—obesity may have cardiovascular benefits, the data and conclusions presented by Buettner et al. should be interpreted with great caution. Comparing the baseline data of normal weight patients (n = 551) with those of severely obese patients (n = 48) presented by Buettner et al.,1 in the former group, there were three times as many patients with prior myocardial infarction (37 vs. 13%), three times as many who had undergone coronary artery bypass surgery (12 vs. 4%), and almost five times as many with a systolic left ventricular ejection fraction of less than 40% (19 vs. 4%). With regard to medical therapy, obese patients more often received renin–angiotensin system inhibitor (64 vs. 51%) or statin therapy (70 vs. 57%). It should also be noted that although there were twice as many diabetics among the severely obese patients (31 vs. 17%), only 6% of these patients received oral anti-diabetic therapy and none of them was treated with insulin. Finally, data on weight development and physical activity during follow-up are not available.
We find it difficult to follow the conclusion put forward by the authors. It is highly likely that the reported improvement in outcome is due to the better overall cardiovascular status, treatment, or changes in lifestyle of obese patients. Indeed, previous myocardial infarction, poor systolic left ventricular function, and extensive atherosclerotic coronary artery disease are associated with poor outcome,4 whereas the renin–angiotensin system inhibitor or statin therapy improves survival in patients with coronary artery disease.4 Similarly, weight loss and/or exercise are known to improve cardiovascular function and mortality.5 In view of the known deleterious effects of obesity and its associated conditions hypertension, insulin resistance, diabetes, and dyslipidaemia3 and given that its prevalence goes much under-diagnosed in European countries,6 it appears daring to propose a beneficial effect of obesity according to the conclusions of Buettner et al. We also believe that early recognition and prevention of obesity, particularly in young patients,2,3,7 remain an important therapeutic goal in cardiovascular medicine, which appears to be underachieved at present.
References
- Buettner HJ, Mueller C, Gick M, Ferenc M, Allgeier J, Comberg T, Werner KD, Schindler C, Neumann FJ. The impact of obesity on mortality in UA/non-ST-segment elevation myocardial infarction. Eur Heart J (2007) 28:1694–1701.
[Abstract/Free Full Text] - McGill HC Jr, McMahan CA, Herderick EE, Zieske AW, Malcom GT, Tracy RE, Strong JP. Obesity accelerates the progression of coronary atherosclerosis in young men. Circulation (2002) 105:2712–2718.
[Abstract/Free Full Text] - Barton M, Furrer J. Cardiovascular consequences of the obesity pandemic: need for action. Expert Opin Investig Drugs (2003) 12:1757–1759.[CrossRef][Web of Science][Medline]
- Braunwald E, Zipes DP, Libby P. Heart disease—A textbook of cardiovascular medicine (2001) 6th edn. Philadelphia: W.B. Saunders.
- Hambrecht R, Wolf A, Gielen S, Linke A, Hofer J, Erbs S, Schoene N, Schuler G. Effect of exercise on coronary endothelial function in patients with coronary artery disease. N Engl J Med (2000) 342:454–460.
[Abstract/Free Full Text] - Bramlage P, Wittchen HU, Pittrow D, Kirch W, Krause P, Lehnert H, Unger T, Hofler M, Kupper B, Dahm S, Bohler S, Sharma AM. Recognition and management of overweight and obesity in primary care in Germany. Int J Obes Relat Metab Disord (2004) 28:1299–1308.[CrossRef][Web of Science][Medline]
- Weghuber D, Zaknun D, Nasel C, Willforth-Ehringer A, Muller T, Boriss-Riedl M, Widhalm K. Early cerebrovascular disease in a 2-year-old with extreme obesity and complete metabolic syndrome due to feeding of excessively high amounts of energy. Eur J Pediatr (2007) 166:37–41.[CrossRef][Web of Science][Medline]
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||