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Study: Obese Heart Attack Patients More Likely to Survive

Reasons Aren't Clear, Researchers Admit

June 20, 2007

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Obese and very obese patients have a lower risk of dying after they have been treated for heart attacks than do normal weight patients, according to research published in the European Heart Journal.

Researchers in Germany and Switzerland found that among patients who had received initial treatment for a specific type of heart attack, those that were obese or very obese were less than half as likely to die during the following three years as patients who had a normal body mass index (BMI).

“Although there is no doubt that people who are overweight, obese and very obese have a higher risk of developing diabetes, hypertension and coronary artery disease, the evidence from our study shows once a coronary event has occurred and been optimally treated, obese patients switch to a more favorable prognosis compared to normal weight patients,” said Dr Heinz Buettner, head of interventional cardiology at Herz-Zentrum, Krozingen, Germany, who led the study.

Dr Buettner and his colleagues followed 1,676 consecutive patients in a prospective study who had been admitted to hospital suffering from unstable angina/non-ST-segment elevation myocardial infarction between 1996 and 1999.

Coronary angiography was performed to diagnose the extent of the problem and then the patients were usually treated with early coronary revascularisation, primarily by inserting stents to widen the relevant artery, or by coronary artery bypass grafting.

A third of the patients (551) had a normal BMI, half (824) were overweight, and 18% (292) were obese or very obese. The obese and very obese patients tended to be younger, more likely to have hypertension and diabetes already, but less likely to have suffered an earlier heart attack.

They were also more likely to be discharged from hospital after treatment with prescriptions for statins, ACE-inhibitors and beta-blockers.

“After three years of follow-up, we found that obese and very obese patients had less than half the long-term mortality when compared with normal BMI patients; 9.9% of normal BMI patients and 7.7% of overweight patients had died at the end of the three years, but only 3.6% of obese patients had died and no very obese patients had died.

The reduction in mortality rates was consistent among all sub-groups and persisted after adjustment for a number of variables. These findings contrast with primary prevention studies that implicate BMI as a strong risk factor for mortality.

“The findings of this study complement and extend our knowledge regarding the impact of obesity on cardiovascular disease by suggesting that the prognostic impact of obesity is confounded by a cardiovascular event such as a heart attack,” according to the study.

“Approximately 2-2.5 million patients worldwide are hospitalized for unstable angina/non-ST-segment elevation myocardial infarction each year. Until now, the impact of obesity on outcomes after revascularisation treatment was unknown.”

Dr Buettner said his study was limited to describing the association observed between obesity and improved survival, and it was not possible to say what might be causing it.

“Further research is necessary to elucidate the underlying pathophysiological mechanisms responsible for the more favourable outcome in obese patients,” he said.

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