Why obesity predispose to heart attack?

Obesity is an important risk factor for heart attack, because it contribute a number of other factors that predispose to heart attack. Obesity is measured in terms of BMI or body mass index. That is body weight divided by height squared. There are 3 levels of obesity.

1. Level 1 - More than 30

2. Level 2 - More than 34.9 less than 40

3. Level 3 - More than 40

Morbid  obesity means more than 50% of ideal body weight.

The risk of heart attack attributed to obesity is very high if the body mass index is more than 40.

Obesity is associated with 

1. Increased calories in the diet.

2. High fat intake.

3. High saturated fat intake.

4. Physical inactivity.

Heart attack risk factors that are influenced by obesity are given below.

1. Metabolic syndrome and insulin resistance.

2. Diabetes mellitus.

3. Hypertension.

4. Increased triglycerides.

5. Low HDL cholesterol.

6. Increased fibrinogen.

7. Increased C-reactive protein.

8. Alteration in blood vessel wall function leading to clot formation.

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Metabolic syndrome... Who is at risk?

Metabolic syndrome increases the risk of diabetes and insulin resistance. Prevalence of the metabolic syndrome is increasing worldwide. Incidence increases with age. Highest  incidence of metabolic syndrome is seen in native Americans. About 60 percentage of females and 45 percentage of men between 40 to 49 age group are affected. Rising prevalence of obesity also increases the metabolic syndrome.

Following are the risk factors of metabolic syndrome.

1. Overweight and obesity.

2. Sedentary lifestyle.

3. Aging.

4. Diabetes.

5. Coronary heart disease.

6. Lipodystrophy.

Overweight and obesity.

Obesity increases the waist circumference and the risk for metabolic syndrome. But people who are of normal weight can also develop insulin resistance and this syndrome.

Sedentary lifestyle.

It is a predictor of heart disease and related mortality. Sedentary lifestyle is associated with increased risk of central obesity, high triglycerides, low HDL (High dencity lipoprotein) cholesterol, high blood pressure and blood sugar. It has two fold increase incidence in those who watch television or computer more than 4 hours, compared to those who watch it less than 1 hour.

Age

As the age advances the risk of metabolic syndrome is increasing, this tendency is seen worldwide. It is seen in 44 percentage of males more than 50 yrs in USA. Incidence is more common in females.

Diabetes mellitus

There is increased incidence of diabetes and insulin resistance in people with metabolic syndrome. This inturn will increase the risk for heart disease.

Heart disease

People with metabolic syndrome have increased incidence of heart disease. This can be reduced by lifestyle and dietary changes and weight reduction.

Lipodystrophy

Both congenital and acquired is associated with metabolic syndrome.

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How will you identify that you have metabolic syndrome.

Obesity a rising problem 

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How will you identify that you have metabolic syndrome.

Identification of metabolic syndrome is important because it will help to predict the risk of future heart disease and diabetic risk. Worldwide more and more people are affected by this. This is due to change in lifestyle and food habits. Metabolic syndrome is highest among native Americans. It has got 5 components. Increased waist circumference is more in females where as fasting triglycerides and hypertension is more common in males.

Five components of metabolic syndrome are the following.

1.Central obesity(waist circumference)

2.Increased triglycerides

3.Low HDL cholesterol.

4.Diabetes mellitus

5.Hypertension

Risk factors of metabolic syndrome

1. Overweight and obesity

2. Aging

3. Heart disease

4. Diabetes mellitus

5. Sedentary lifestyle 

6. Lipodystrophy

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Obesity a rising problem

Obesity is a chronic metabolic disorder with excessive fat deposition in the body .WHO defines obesity as body mass index more than  30 kg/m². Incidence of obesity is increasing worldwide, also in developing countries. As the people get older they accumulate more fat. Obesity indicate an excess fat storage, and looking at the undressed patient it can be easily identified. The term  overweight (rather than obese) indicate individuals with BMI between 25 and 30. It is medically significant and worthy of therapeutic intervention, especially in persons with  risk factors such as hypertension and glucose intolerance.

The distribution of adipose tissue in the body is important and has implications for morbidity. Intra-abdominal and abdominal subcutaneous fat have more significance compared to subcutaneous fat in the buttocks and lower extremities. This is clinically  detected  by the waist-to-hip ratio, with a ratio > 0.9 in women and >1.0 in men being abnormal. This may be because intra-abdominal adipocytes are more lipolytically active than those from other sites. 

Incidence of obesity is increasing  because of the following 

1. Increased availability of energy rich drinks and foods.
2. Increase in labour-saving devices (e.g. lifts and remote controls).
3. Increase in passive transport(cars as opposed to walking)

Obesity can be simple obesity or it can be associated with other conditions. Most  patients have simple obesity, Even when it is associated with other conditions, excess calories consumed in the diet  than expenditure through exercise and body functions, is the main cause of obesity.

Energy balance

1. 1 kg body weight gained has energy of approx 7000 kcal.
2. 10 kg weight gain over 5 years -70000/5*365=_ _38 kcal/day.
3. This is a daily error of energy balance of _1.5%.
4. OR 10 minutes’ walk.
5. OR one square (1/8) of a 2oz milk chocolate bar.
6. OR half a digestive biscuit.

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