Tags

Type your tag names separated by a space and hit enter

The obesity paradox, weight loss, and coronary disease.
Am J Med. 2009 Dec; 122(12):1106-14.AJ

Abstract

PURPOSE

Because obesity is a cardiovascular risk factor but is associated with a more favorable prognosis among cohorts of cardiac patients, we assessed this "obesity paradox" in overweight and obese patients with coronary heart disease enrolled in a cardiac rehabilitation and exercise training (CRET) program, making this assessment in patients classified as overweight/obese using both traditional body mass index (BMI) and percent body fat assessments. Additionally, we assessed the efficacy and safety of purposeful weight loss in overweight and obese coronary patients.

PATIENTS AND METHODS

We retrospectively studied 529 consecutive CRET patients following major coronary events before and after CRET, and compared baseline and post program data in 393 overweight and obese patients (body mass index [BMI] > or =25 kg/m(2)) divided by median weight change (median=-1.5%; mean +2% vs -5%, respectively). In addition, we assessed 3-year total mortality in various baseline BMI categories as well as compared mortality in those with high baseline percent fat (>25% in men and >35% in women) versus those with low baseline fat.

RESULTS

Following CRET, the overweight and obese with greater weight loss had improvements in BMI (-5%; P <.0001), percent fat (-8%; P <.0001), peak oxygen consumption (+16%; P <.0001), low-density lipoprotein cholesterol (-5%; P <.02), high-density lipoprotein cholesterol (+10%; P <.0001), triglycerides (-17%; P <.0001), C-reactive protein (-40%; P <.0001), and fasting glucose (-4%; P=.02), as well as marked improvements in behavioral factors and quality-of-life scores. Those with lower weight loss had no significant improvements in percent fat, low-density lipoprotein cholesterol, triglycerides, C-reactive protein, and fasting glucose. During 3-year follow-up, overall mortality trended only slightly lower in those with baseline overweightness/obesity who had more weight loss (3.1% vs 5.1%; P=.30). However, total mortality was considerably lower in the baseline overweight/obese (BMI > or =25 kg/m(2)) than in 136 CRET patients with baseline BMI <25 kg/m(2) (4.1% vs 13.2%; P <.001), as well as in those with high baseline fat compared with those with low fat (3.8% vs 10.6%; P <.01).

CONCLUSIONS

Purposeful weight loss with CRET in overweight/obese coronary patients is associated with only a nonsignificant trend for lower mortality but is characterized by marked improvements in obesity indices, exercise capacity, plasma lipids, and inflammation, as well as behavioral factors and quality of life. Although an "obesity paradox" exists using either baseline BMI or baseline percent fat criteria, these results support the safety and potential long-term benefits of purposeful weight loss in overweight and obese patients with coronary heart disease.

Authors+Show Affiliations

Cardiac Rehabilitation, Exercise Laboratories, Ochsner Health System, New Orleans, LA 70121-2483, USA. clavie@ochsner.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19682667

Citation

Lavie, Carl J., et al. "The Obesity Paradox, Weight Loss, and Coronary Disease." The American Journal of Medicine, vol. 122, no. 12, 2009, pp. 1106-14.
Lavie CJ, Milani RV, Artham SM, et al. The obesity paradox, weight loss, and coronary disease. Am J Med. 2009;122(12):1106-14.
Lavie, C. J., Milani, R. V., Artham, S. M., Patel, D. A., & Ventura, H. O. (2009). The obesity paradox, weight loss, and coronary disease. The American Journal of Medicine, 122(12), 1106-14. https://doi.org/10.1016/j.amjmed.2009.06.006
Lavie CJ, et al. The Obesity Paradox, Weight Loss, and Coronary Disease. Am J Med. 2009;122(12):1106-14. PubMed PMID: 19682667.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The obesity paradox, weight loss, and coronary disease. AU - Lavie,Carl J, AU - Milani,Richard V, AU - Artham,Surya M, AU - Patel,Dharmendrakumar A, AU - Ventura,Hector O, Y1 - 2009/08/13/ PY - 2008/09/30/received PY - 2009/05/06/revised PY - 2009/06/02/accepted PY - 2009/8/18/entrez PY - 2009/8/18/pubmed PY - 2010/1/19/medline SP - 1106 EP - 14 JF - The American journal of medicine JO - Am J Med VL - 122 IS - 12 N2 - PURPOSE: Because obesity is a cardiovascular risk factor but is associated with a more favorable prognosis among cohorts of cardiac patients, we assessed this "obesity paradox" in overweight and obese patients with coronary heart disease enrolled in a cardiac rehabilitation and exercise training (CRET) program, making this assessment in patients classified as overweight/obese using both traditional body mass index (BMI) and percent body fat assessments. Additionally, we assessed the efficacy and safety of purposeful weight loss in overweight and obese coronary patients. PATIENTS AND METHODS: We retrospectively studied 529 consecutive CRET patients following major coronary events before and after CRET, and compared baseline and post program data in 393 overweight and obese patients (body mass index [BMI] > or =25 kg/m(2)) divided by median weight change (median=-1.5%; mean +2% vs -5%, respectively). In addition, we assessed 3-year total mortality in various baseline BMI categories as well as compared mortality in those with high baseline percent fat (>25% in men and >35% in women) versus those with low baseline fat. RESULTS: Following CRET, the overweight and obese with greater weight loss had improvements in BMI (-5%; P <.0001), percent fat (-8%; P <.0001), peak oxygen consumption (+16%; P <.0001), low-density lipoprotein cholesterol (-5%; P <.02), high-density lipoprotein cholesterol (+10%; P <.0001), triglycerides (-17%; P <.0001), C-reactive protein (-40%; P <.0001), and fasting glucose (-4%; P=.02), as well as marked improvements in behavioral factors and quality-of-life scores. Those with lower weight loss had no significant improvements in percent fat, low-density lipoprotein cholesterol, triglycerides, C-reactive protein, and fasting glucose. During 3-year follow-up, overall mortality trended only slightly lower in those with baseline overweightness/obesity who had more weight loss (3.1% vs 5.1%; P=.30). However, total mortality was considerably lower in the baseline overweight/obese (BMI > or =25 kg/m(2)) than in 136 CRET patients with baseline BMI <25 kg/m(2) (4.1% vs 13.2%; P <.001), as well as in those with high baseline fat compared with those with low fat (3.8% vs 10.6%; P <.01). CONCLUSIONS: Purposeful weight loss with CRET in overweight/obese coronary patients is associated with only a nonsignificant trend for lower mortality but is characterized by marked improvements in obesity indices, exercise capacity, plasma lipids, and inflammation, as well as behavioral factors and quality of life. Although an "obesity paradox" exists using either baseline BMI or baseline percent fat criteria, these results support the safety and potential long-term benefits of purposeful weight loss in overweight and obese patients with coronary heart disease. SN - 1555-7162 UR - https://www.unboundmedicine.com/medline/citation/19682667/The_obesity_paradox_weight_loss_and_coronary_disease_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9343(09)00500-2 DB - PRIME DP - Unbound Medicine ER -