Morbid Obesity Levels the Playing Field for
Cardiovascular Risk Between Men, Women
Interestingly, excess obesity appears to offer
protection from heart attack
March 31, 2008 - Heart disease remains the leading
killer of men and women; but while men tend to be at greater risk for
developing heart problems, cardiovascular risk profiles often vary
between genders. A new study suggests such gender-related differences
disappear in patients who are morbidly obese compared to those who are
overweight or obese, according to data presented today at the American
College of Cardiology’s 57th Annual Scientific Session.
Researchers attribute this phenomenon to high
levels of estrogen in men with morbid obesity, which makes them more
similar to females than their overweight or obese counterparts.
“Our data suggests that patients’ cardiovascular
risk profile is associated with their gender largely because of
differences in hormones. When these differences are reduced, as we see
in morbidly obese patients, risk factors are similar,” said Luigi
Biasucci, M.D., of Catholic University in Rome.
“These findings suggest that the relationship
between risk factors and disease may be more complex than believed.”
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Morbidly obese patients have high levels of
estrogen due to expanded subcutaneous fat tissue (stored under the
skin), which converts the male sex hormone, androgen, into estrogen
through a converting enzyme, called aromathasis.
Excess obesity does not carry additional
cardiovascular risk, according to the data. In fact, morbidly obese
subjects appear to have a lower incidence of high blood pressure and
cholesterol—both important risk factors for heart disease.
“Morbid obesity may be somehow protective due, in
part, to increased estrogen levels,” said Dr. Biasucci.
“The risk of ischemic heart disease and heart
attack is lower in morbidly obese patients compared to those who are
overweight or obese. However, these patients may have a higher risk of
heart failure, cancer and pulmonary disease, so it’s certainly not
safe.”
This study enrolled 71 healthy patients with no
signs of diabetes or heart disease. Subjects were divided into two
groups based on their body mass index (BMI).
>> Group 1 included 48 patients with BMI ranging
from 20 to 39.9.
>> Group 2 was comprised of 23 morbidly obese
patients with BMI greater than 40.
Cardiovascular risk factors were assessed and
compared in relation to gender differences.
In the overweight and obese group, weight, waist
circumference, triglycerides, leptin levels, median intima-media
thickness (a measure of atherosclerosis), number of patients with
carotid plaques and hypertension were significantly lower in females
compared to males.
Conversely, HDL (“good” cholesterol) and estrogen
levels were higher in females. In contrast, no significant differences
between males and females were found in morbidly obese patients.
Based on these results, researchers believe
cardiovascular risk needs to be differentially assessed in patients with
morbid obesity compared to others. This will better inform patients’
treatment plan. “For morbidly obese patients, it may be less important
to focus on triglycerides and cholesterol than to encourage weight
loss,” adds Dr. Biasucci. “This doesn't mean these patients can drink
[alcohol] excessively, smoke, not reduce high cholesterol and so on, but
differentiating their risk profile can help clinicians prioritize
efforts to reduce cardiovascular risk.”
Dr. Biasucci presented Morbid Obesity Abolishes
Gender Differences in Cardiovascular Risk Factors on Saturday, March
29.
Editor’s Notes:
The American College of Cardiology (www.acc.org)
represents the majority of board certified cardiovascular physicians in
the United States. Its mission is to advocate for quality cardiovascular
care through education, research, promotion, development and application
of standards and guidelines- and to influence health care policy. ACC.08
is the largest cardiovascular meeting, bringing together cardiologists
and cardiovascular specialists to share the newest discoveries in
treatment and prevention, while helping the ACC achieve its mission to
address and improve issues in cardiovascular medicine.
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March 31, 2008 - Heart disease remains the leading
killer of men and women; but while men tend to be at greater risk for
developing heart problems, cardiovascular risk profiles often vary
between genders. A new study suggests such gender-related differences
disappear in patients who are morbidly obese compared to those who are
overweight or obese, according to data presented today at the American
College of Cardiology’s 57th Annual Scientific Session. 
