Certain Risk Factors Could Spur Heart Failure in
WEDNESDAY, Sept. 14 (HealthDay News) -- Normal-weight patients
diagnosed with a cluster of factors known as the "metabolic
syndrome" could face a higher risk for heart failure than even
obese patients without such factors, new research suggests.
Metabolic syndrome is characterized by a group of symptoms --
increased blood pressure, higher-than-normal insulin levels, excess
body fat around the waist, high triglycerides and/or abnormal
cholesterol levels -- that raise the risk of stroke, heart disease
A healthy metabolic profile, in turn, is marked by the absence
of those symptoms, suggesting the major organs systems are in
The new study suggests that being obese is not as much of a
threat for heart failure as are those specific factors that
typically contribute to a diagnosis of metabolic syndrome. These
include having an "apple shape" (carrying extra weight around the
middle and upper part of the body) and developing insulin
resistance, leading to an unhealthful spike in blood sugar and
blood lipid (fat) levels.
Study lead author Dr. Christina Voulgari, from the first
department of cardiology at Athens University Medical School at
Hippokration Hospital in Athens, Greece, said that the findings
suggest that "we should focus not on weight loss at any given cost
but (on) a healthier lifestyle" -- one, for example, that embraces
exercise and eschews smoking.
Voulgari, also with Laiko General Hospital in Athens, and
colleagues report their findings in the Sept. 20 issue of the
Journal of the American College of Cardiology.
The authors explained that their investigation arose out of
interest in those who are exceptions to the rule: those individuals
who maintain a healthy metabolic profile despite being obese.
While metabolic syndrome and obesity more often than not go hand
in hand, some obese patients buck the trend by retaining high
insulin sensitivity, good blood pressure readings and positive
glycemic, inflammation and lipid profiles.
But do such individuals, in turn, face a lower risk for heart
failure than non-obese men and women who nonetheless struggle with
the tell-tale signs of metabolic syndrome?
To explore the question, the research team tracked 550 men and
women for an average of six years.
The patients were enlisted between 2003 and 2005, and none had a
history of diabetes or signs of cardiac illness at the study
Questionnaires were completed at the launch to gather
information on health status, weight and body mass index, physical
activity habits, and those factors that fall under the rubric of a
metabolic syndrome evaluation.
As expected, the team found that about half of the participants
had metabolic syndrome, and that obese patients were more likely to
have it than those who were of normal weight or just
That said, the authors drilled down on the health status of
those 185 patients, with an average age of just under 60, who
ultimately experienced heart failure during the study period.
The results: heart failure risk appeared to be much higher among
patients with metabolic syndrome than among those without,
regardless of weight status. And, obese patients without metabolic
syndrome were found to experience the lowest heart failure
incidence rate of any category of patients.
For example, among patients who were not diagnosed with
metabolic syndrome, heart failure incidence was roughly 9 percent
among obese men and women, 14 percent among overweight patients,
and 16 percent among those of normal weight.
This compared very favorably with patients who did have the
metabolic syndrome. Among that group, heart failure incidence was
much higher, hitting approximately 54 percent among the obese, 48
percent among the overweight, and 63 percent among those of normal
The four metabolic syndrome factors associated with heart
failure were impaired fasting glucose, low "good" HDL cholesterol,
high blood pressure and excess abdominal fat (central obesity).
Insulin resistance and inflammation -- also associated with
metabolic syndrome -- were also independently linked to heart
All told, having metabolic syndrome conferred a 2.5-fold greater
relative risk for experiencing heart failure.
The team concluded that metabolic syndrome (and insulin
resistance and inflammation, in particular) is a significant and
independent marker of heart failure risk, and is more of a warning
sign than obesity alone.
Commenting on the study, Dr. Robert Scott III, an associate
professor of internal medicine at Texas A&M Health Science
Center College of Medicine and a senior staff cardiologist at Scott
& White in Temple, Texas, said the findings clearly suggest
that metabolic syndrome "is the bad actor at play."
"Yes, in general, obesity is a bad thing," he noted. "But it's not everything. And here we have a bit of fine-tuning that suggests that the important thing with obesity tends to be the metabolic syndrome."
"And that means," Scott added, "that if you have this constellation of factors -- high blood pressure, low HDL, high sugar levels -- you are going to face a much higher risk for coronary heart disease and congestive heart failure. Even if you're not obese."
But Dr. Gregg C. Fonarow, a professor of cardiovascular medicine
at University of California, Los Angeles, said that while the study
drives home the notion that metabolic risk factors are key to heart
disease risk, obesity is still a problem.
A Scottish study published earlier this year in the journal
Heart, for example, indicated that obese men face a much higher risk of dying from a heart attack, whether or not they also struggle with independent cardiovascular risk factors such as high blood pressure and high cholesterol.
The Greek researchers "are just looking at heart failure here,"
he noted. "But obesity also comes along with a higher risk for
diabetes, cancer and shortened survival overall. So it's not that
one's overall health in the long-term will not be adversely
affected by being obese. Getting to a healthy body weight, of
course, remains as important as ever."
For more on the metabolic syndrome, visit the
U.S. National Library of Medicine.
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