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Obese heart patients 'do better'


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#1    Star of the Sea

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Posted 17 March 2013 - 06:03 PM

This is despite them reporting worse health and being less likely to follow lifestyle advice, a study of more than 4,400 patients reported. One explanation is that doctors treat the disease more aggressively, the University College London team said.....cont/..


http://www.bbc.co.uk...acebook_bbcnews


Well you could knock me down with a feather with this bit of news :unsure2:

Edited by Star of the Sea, 17 March 2013 - 06:04 PM.

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#2    ouija ouija

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Posted 17 March 2013 - 06:15 PM

View PostStar of the Sea, on 17 March 2013 - 06:03 PM, said:

Well you could knock me down with a feather with this bit of news :unsure2:

You're obviously not obese then! :lol:

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#3    Lilly

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Posted 17 March 2013 - 06:17 PM

Here's what I've been wondering for some time now: Perhaps the current medical notion of what's a "normal weight" simply isn't correct? I mean, perhaps 'thin as a stick' with just about no body fat really isn't normal/healthy after all? I'd be very curious to see how only slightly heavier people (who don't smoke/drink and do exercise) fare in these cardiac situations? I have a very strong suspicion that slightly heavier (not obese) people will be found to have the very best survival rates.

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#4    Queen in the North

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Posted 17 March 2013 - 06:37 PM

Maybe heart disease is caught sooner in obese patients? They are more likely to have other health problems, more visits to the GP, maybe more tests... Whereas 'normal' people don't have as many other health problems and feel fine until, you know, the ol' ticker stops working, when the heart disease will have progressed further before treatment.

Just a thought off the top of my head.

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#5    Star of the Sea

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Posted 17 March 2013 - 06:45 PM

View PostLilly, on 17 March 2013 - 06:17 PM, said:

Here's what I've been wondering for some time now: Perhaps the current medical notion of what's a "normal weight" simply isn't correct? I mean, perhaps 'thin as a stick' with just about no body fat really isn't normal/healthy after all? I'd be very curious to see how only slightly heavier people (who don't smoke/drink and do exercise) fare in these cardiac situations? I have a very strong suspicion that slightly heavier (not obese) people will be found to have the very best survival rates.

I think you could be right Lilly about slightly heavier people having better survival rates, so long as they don't smoke and drink etc. So I wonder if BMI charts will change after this research. My husband LOL at this because he had a heart attack just over two years ago and all he hears from the Doctors is "lose weight". Steak pie for tea then! (not!)

Edited by Star of the Sea, 17 March 2013 - 06:47 PM.

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#6    Ashotep

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Posted 17 March 2013 - 07:31 PM

I tend to agree with Queen in the North.  Obese people have other health issues and see a doctor much more often starting earlier in life.  However I don't think stick skinny is healthy either.  I think someone in the middle are the healthiest and are probably closer to what should be considered normal weight.


#7    and then

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Posted 17 March 2013 - 07:48 PM

It might also be that if the cause of the heart condition is the obesity and not , smoking, for example, the outcomes could be better though I can't imagine why.

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#8    Ashotep

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Posted 17 March 2013 - 08:13 PM

Overweight people that never smoke have heart problems, I know a couple of them.  The doctor told them to lose weight but they just keep getting fatter and never exercise.  This woman came into my flea market one day and could barely walk up a couple of stairs because of her weight.  She was only in her thirties and probably weighted 200 pounds.  Then I know a man that is really overweight but he doesn't sit around and does just fine.  However he's not that old yet.


#9    Star of the Sea

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Posted 17 March 2013 - 08:22 PM

My hubby is slightly overweight but not obese. He had a heart check a couple of weeks ago and his heart function hasn't deteriorated but more or less stayed the same from when he had the heart attack. He is on a cocktail of drugs though which keeps his BP down etc. I think a good 'rule of thumb' is to keep most things in moderation.  If you eat too many fatty foods it hardens the arteries so I think it's wise to keep to a low fat diet.. so no fry ups!

Edited by Star of the Sea, 17 March 2013 - 08:36 PM.

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#10    Star of the Sea

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Posted 17 March 2013 - 08:27 PM

I can't get my head round this part of the article:

"But obese patients who did not stick to these healthy lifestyle recommendations still had a lower risk of death than normal weight patients who smoked or were inactive".

:unsure2:

Edited by Star of the Sea, 17 March 2013 - 08:27 PM.

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#11    Star of the Sea

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Posted 17 March 2013 - 08:33 PM

View Postand then, on 17 March 2013 - 07:48 PM, said:

It might also be that if the cause of the heart condition is the obesity and not , smoking, for example, the outcomes could be better though I can't imagine why.
I

It appears and I could be wrong that 'smoking' is far more serious for your health than being obese?

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#12    Star of the Sea

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Posted 17 March 2013 - 08:46 PM

View PostHilander, on 17 March 2013 - 08:13 PM, said:

Overweight people that never smoke have heart problems, I know a couple of them.  The doctor told them to lose weight but they just keep getting fatter and never exercise.  This woman came into my flea market one day and could barely walk up a couple of stairs because of her weight.  She was only in her thirties and probably weighted 200 pounds.  Then I know a man that is really overweight but he doesn't sit around and does just fine.  However he's not that old yet.

I think exercise makes a massive difference to your health. So even if you are over weight, but get regular exercise you are healthier as it get's the old tick tock working :)

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#13    Lilly

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Posted 17 March 2013 - 09:15 PM

View PostStar of the Sea, on 17 March 2013 - 08:27 PM, said:

I can't get my head round this part of the article:

"But obese patients who did not stick to these healthy lifestyle recommendations still had a lower risk of death than normal weight patients who smoked or were inactive".

:unsure2:

Yeah, that's the really weird part...which is why I was wondering if they defined "normal weight" as being Hollywood stick thin?

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#14    Frank Merton

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Posted 18 March 2013 - 01:04 PM

Yea.  The best is to be thin and fit; the next is to be fat and fit.   Then comes thin and unfit and finally fat and unfit.


#15    Copasetic

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Posted 18 March 2013 - 02:47 PM

The article is poorly written and the comments in it aren't very current with the studies that have been done. BMI by itself is a poor predictor of health because it doesn't take into consideration distribution of body fat nor does it consider various tissue densities. For example some one could be 5'10" and cut because they are gym rat, but have a high BMI because of all the muscle.

When researchers have gone back and looked at these "obesity paradox" studies and included things like waist circumference and waist-hip-ratio in measuring their cohorts overall mortality the "obesity paradox" vanishes.

Also this article isn't very context specific. Different disease process are different and that has to be considered as well. For example, when looking a cohorts of cancer patients people who were initially heavy do typically tend to do better and that probably has to do with the fact their bodies take longer to get cachexic than do "normal weight" or underweight people.

Coronary artery disease (CAD) is another one that needs discussed in specifics. You can divide the pathophysiology of myocardial infarcts (MI) into two broad groups: think of it like the "suddens" and the "slows".

Its kind of counter-intuitive. Think of the blood vessels on the heart like a pipe carrying water. That pipe over time becomes occluded by fatty plaques due to inflammation and cholesterol deposition. You would think that having your pipe 70% occluded is worse than 40% occluded, but that isn't necessarily the case because the pathophysiology is different. In obese patients with high cholesterol the deposition is slow and collateral circulation develops to help meet myocardial oxygen demands. When these patients have MIs they tend to do better because this collateral circulation helps prevent some ischemic damage to the heart. These heavy patients with slow occlusion are likely due to more environmental factors--That is to say they have high cholesterol because they eat like crap and don't get enough exercise.

On the other hand you have this other group of people who may not be overweight and get "massive heart attacks" and die abruptly at young ages (smokers also tend to fall into this category). The pathophysiology of plaque deposition is different in these people. If you look at their "water pipes" you see they aren't as occluded--say 40%. So no problem right? The problem is their plaques are unstable and prone to rupture. When a plaque ruptures an emboli travels down stream to smaller "pipes" and occludes the blood supply. This is a major problem because in these people the plaques developed quickly and without time for collateral circulation to develop. Ergo when they have a myocardial event the ischemic damage is usually massive and fatal.





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