Featured Research: Today’s Obese Patients Are at Greater Risk
Progress in the prevention and treatment of
cardiovascular disease is a notable advance in medicine. However, the steady growth in obesity and diabetes cases has undercut the good news. Not only are there many more people who are overweight or obese, as well as have type 2 diabetes, but a
recent study in the Journal of the American Heart Association reported that today’s obese Americans have more cardiac risk factors and a greater risk of type 2 diabetes than was true in the 1980s.
The study, conducted through the annual National Health and Nutrition Examination Survey, followed 18,626 obese adults from 1988 to 2014. The researchers found that the percentage of people who had three cardiac risk factors — hypertension, hypercholesterolemia and high blood glucose — increased from 16 percent in 1988 to 22 percent in 2014.
It’s complicated, says
Jonathan Greene, MD, an Emerson cardiologist. “Cardiovascular disease and myocardial infarctions have declined, largely due to the use of statins, aspirin and new medications, as well as stents,” he notes. “But we have more unhealthy patients due to obesity and diabetes.
“We know that drugs and stents are keeping a certain amount of cardiovascular disease at bay, but much of the progress we’ve made is being undone by the increased obesity and diabetes,” Dr. Greene adds. As a cardiologist, he considers diabetes to be the red flag of greatest concern. “Once you have it, your risk for coronary artery disease [CAD] is very high,” he says. “In fact, diabetes is the biggest risk factor for CAD.
Bariatric surgery has a role to play. It significantly improves diabetes.”
This is clear from results of the
STAMPEDE trial, which showed that bariatric surgery is superior to intensive medical therapy alone in achieving glycemic control in obese patients. “We now have five-year outcomes from STAMPEDE,” says Dr. Greene. “As I tell patients, bariatric surgery not only produces predictable weight loss, it changes the body metabolically. I explain they will live seven years longer, on average, if they have bariatric surgery.”
Education is key in managing patients who are obese, especially when they also have diabetes. “Patients need to understand the impact of obesity and diabetes on their health,” he says. “These are lifelong diseases. The longer they go untreated, the greater the impact on an individual’s health.”
