Obesity paradox seen in people with heart disease

NEW YORK (Reuters Health) - The "obesity paradox" -- an unexpected decrease in illness and death with increasing body weight or BMI, which has been described in people with heart failure and in patients having angioplasty -- exists in people with high blood pressure and diseased heart arteries as well, new study findings show.

In the study, researchers found that overweight and obese adults with high blood pressure and coronary artery disease had a lower risk of heart attack, stroke or death, compared with their normal-weight counterparts.

The reasons for the apparent protective effect of increased BMI in these populations "are unclear," note Dr. Seth Uretsky from St. Luke's-Roosevelt Hospital in New York City and colleagues in the American Journal of Medicine.

They investigated the effect of overweight and obesity on heart-related outcomes in 22,576 people with treated high blood pressure and coronary artery disease who participated in a large study.

Compared to normal-weight subjects with a BMI between 20 and 25, the risk of death, heart attack, or stroke was lower in subjects who were overweight (BMI 25 to 30), and in those with class I obesity (BMI 30 to 35) and class II-III obesity (BMI 35 or greater).

"This 'obesity paradox' occurred in men and women across all age groups, even though blood pressure was better controlled in normal-weight patients," the investigators note.

In a commentary, Dr. Carl J. Lavie and colleagues of the Ochsner Medical Center, New Orleans caution that while improved outcomes appear to be consistently associated with increased BMI, "one should not conclude that weight reduction is detrimental in overweight populations."

Results of numerous studies, they point out, clearly support the benefits of "purposeful weight reduction" in obese patients with heart disease, despite the obesity paradox.

"As we continue to investigate the obesity paradox in cardiovascular disease ... we should remember the old proverb, "Only one thing is certain - that is nothing is certain," Lavie and colleagues advise.

SOURCE: American Journal of Medicine, October 2007.