Morbid obesity trumps gender differences for cardiovascular risks

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CHICAGO—While 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 by Luigi Biasucci, MD, on Saturday at the 2008 American College of Cardiology (ACC) Scientific Sessions.
The researchers from Catholic University in Rome attribute the 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 Biasucci. “These findings suggest that the relationship between risk factors and disease may be more complex than believed.”

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, Biasucci reported.

“Morbid obesity may be somehow protective due, in part, to increased estrogen levels,” said 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.”

The study enrolled 71 healthy patients with no signs of diabetes or heart disease, and the 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, Biasucci said.

In the overweight and obese group, weight, waist circumference, triglycerides, leptin levels, median intima-media thickness, number of patients with carotid plaques and hypertension were significantly lower in females compared to males, he reported. Conversely, the researchers found that HDL and estrogen levels were higher in females.

In contrast, no significant differences between males and females were found in morbidly obese patients.

Based on the results, the researchers suggest that cardiovascular risk needs to be differentially assessed in patients with morbid obesity compared to others, which 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,” concluded 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.”