Obesity alone not linked to fatal heart attacks
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Being overweight or obese, in the absence of high blood pressure, does not clearly increase the risk of death from heart attack or stroke, French researchers report in the journal Hypertension: Journal of the American Heart Association.
“The role of obesity and overweight as independent risk factors for (heart attack and stroke) is still debated,” Dr. Athanase Benetos and colleagues from the Centre d’Investigations Preventives et Cliniques in Paris write.
The team studied the impact of overweight on fatal heart attacks or strokes according to the presence or absence of associated risk factors, such as high blood pressure and diabetes, in more than 240,000 adults who had a standard health checkup between 1972 and 1988 and were followed for an average of 14 years.
Forty-two percent of the men and 21 percent of the women were overweight and about 5 percent in each group were obese. In both sexes, the rate of high blood pressure, diabetes, and high cholesterol increased significantly with increasing overweight status.
During follow-up, 2949 men and 929 women died of heart attack or stroke.
Overweight subjects without associated risk factors did not have an increased risk of heart attack or stroke death compared with normal weight subjects.
However, men and women who were overweight and had high blood pressure had about double the risk for heart attack or stroke death relative to men and women who were overweight with normal blood pressure.
In both men and women, being overweight and having diabetes only or high cholesterol only did not increase the risk of death from heart attack or stroke.
The National Institutes of Health has further defined high blood pressure. These categories are for people 18 years and older who do not take medication for high blood pressure and do not have a short-term serious illness. These categories are as follows.
- Normal blood pressure is a systolic blood pressure of less than 130, and a diastolic pressure of less than 85.
- High normal blood pressure is a systolic blood pressure of 130 to 139, and a diastolic pressure of 85 to 89.
- Stage 1 high blood pressure is a systolic blood pressure of 140 to 159, and a diastolic pressure of 90 to 99.
- Stage 2 high blood pressure is a systolic blood pressure of 160 to 179, and a diastolic pressure of 100 to 109.
- Stage 3 high blood pressure is a systolic blood pressure of 180 or higher, or a diastolic blood pressure of 110 or higher.
By contrast, in the presence of high blood pressure, the risk of heart attack or stroke death “dramatically increased” in overweight subjects with high cholesterol or diabetes.
High blood pressure was the most important factor associated with increased risk of heart attack or stroke deaths in overweight subjects, Benetos said in a statement. Therefore, the best way to reduce risk is through “treatment that targets both blood pressure and weight reduction.”
The finding, Dr. Frank B. Hu of the Harvard School of Public Health added in a related editorial, “underscores the importance of (high blood pressure) as a mechanism through which obesity causes” heart attacks and strokes.
SOURCE: Hypertension, September 2005.
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