Showing posts with label Obesity. Show all posts
Showing posts with label Obesity. Show all posts

Monday, September 03, 2007

More Evidence on Abdominal Adiposity and CAD

The lastest issue of the Journal of the American College of Cardiology carry a study by the University of Texas, which again found an association between abdominal adiposity and CAD. They define abdominal adiposity as a abdominal girth in excess of 32 inches in females and 37 inches in males. They use calcium score on MSCT as an early index of CAD.

Instead of just measuring abdominal girth, they found that waist to hip ratio (WHR) was an even better index. This is of course not new news, as we have had many studies before which have taught us that WHR was a better predictor of CAD than just weight, or BMI alone. The Japanese have gone further that abdominal adiposity is associated with a lack of adiponectin and an increase in inflammatory markers, suggesting that the abdominal adiposites are actively promoting inflammation and lowering the protective effect of adiponectin.

Of course we are not forgetting that abdominal adiposity is also strongly associated with the metabolic syndrome, which is strongly predictive of CAD. Looks like the evidence here is very strong and fairly well worked out. What is even more encouraging is that reversing the abdominal girth also lessens the CAD risk, giving all us us with large abdominal girth, hope to better ourselves. There is also a follow-up study in UK which showed that if we walk briskly, for 15-30 mins daily can help lose our abdominal girth, lose our weight and also lessens our CAD risk.

Of course, it looks like the Italians will top us again. In the small Italian town of Varallo Sesia, a town of about 7,500 people, the Mayor has offered to reward any obese citizens of the town 50 euros for every 3 Kgs lost in a month and if you can maintain this lost for 5 months, you get another 100 euros. How about that. Needless to say, that many lined up to register. You must be medical certified, of course, before you can collect your money. Well there you are, obesity and shedding obesity, has its rewards, and not just CAD protection.

Sunday, June 24, 2007

THE OBESITY PARADOX

The latest online (20th June) European Heart Journal carried a very interesting article by Dr Heinz Buettner and colleagues who showed that obese and very obese patients do better and live longer after PCI for acute coronary syndrome.

Conversely, it is true that obese patients run a higher risk of hypertension and diabetes, often resulting in coronary artery disease, and acute coronary syndrome. Once the obese patient develops acute coronary syndrome,and undergo PCI, the more obese you are, the better your in-hospital and also better 1 year mortality.

How amazing. Now my obese patients may turn around and tell me that it is better to be fat. I certainly do not know how to explain these findings. In fact this latest findings in the 20th June, follows another piece of work which was reported essentially the same findings. The on-going BARI trial may shed some light into this findings. I know that whenever we have to intervene in an obese patient, we fear as they post great technical challenges due to their size, and also even greater challenge should we have to resuscitate them should the need arises. We hope that this interesting finding will be collaborated by other workers. In the meantime, we should continue to advice a strategy of diet and exercise, to lose weight. There are many paradoxes in medical science, but this must stand as one of the most paradoxical of them all.

It does not mean it's ok to be fat.