People who survive a major heart attack are more likely to do better in the years that follow if they are mildly obese, say cardiologists from the University of Texas Southwestern Medical Center.
In the three years after an attack, people who were mildly obese were 30 percent more likely to survive and spend fewer days in the hospital than those of normal weight. Researchers defined "mildly obese" as having a body mass index (BMI) of 30 to 34.9 compared to a BMI between 18.5 and 24.9, which is considered normal weight.
"I think the message from this finding is that if you've had a heart attack and you're overweight or mildly obese, you shouldn't necessarily try to lose weight aggressively in the initial period after the heart attack," said cardiologist Dr. Ian Neeland. "The finding does not suggest that heart attack patients should try to gain weight if they are of normal weight."
"Also, doctors should focus more on heart attack patients who are normal weight and not assume that just because they're normal weight that they're probably going to be better off," said Neeland, first author of the study and Assistant Professor of Internal Medicine.
The new study expands a growing body of evidence showing that patients with some chronic illnesses who are mildly obese can have better outcomes compared with people of normal weight — a finding called the obesity paradox.
In an earlier study published in the European Heart Journal: Quality of Care and Clinical Outcomes, UT Southwestern researchers examined records from 19,499 Medicare patients discharged after a heart attack involving total artery blockage, then compared them with later treatment records to determine how the patients fared over the next three years. The mildly obese patients did better than all other groups, while those who were of normal weight or extremely obese fared the worst.
More than 10 years ago, Dr. Carl J. Lavie, a cardiologist at New Orleans' Oschner Heart and Vascular Institute, realized that his patients who were overweight had half the mortality rate of normal-weight people who were recovering from heart failure.
About the same time, Dr. Luis Gruberg at the Cardiovascular Research Institute in Washington found that overweight and obese patients died at half the rate of normal-weight people following angioplasty, and nicknamed the phenomenon the "obesity paradox."
The obesity paradox extends to other health problems. A British study found that people with Type 2 diabetes who were overweight, but not obese, had a lower risk of dying over a decade than their counterparts who were normal weight or underweight.
"One theory is that you have more energy reserves to combat the illness," Neeland said. "You're able to weather the storm better."
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