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Morbid Obesity linked to Heart Failure and High Mortality
Morbid Obesity linked to Heart Failure and High Mortality -- Posted by Sweet Zombie Jesus! on 06-13-05 08:24
BACKGROUND: We are in the midst of an obesity pandemic. Morbid obesity
is associated with dyspnea on exertion and higher overall mortality
rates. The relations between measures of cardiorespiratory fitness in
morbidly obese persons compared to those with heart failure are
unknown.
METHODS: We compared cardiorespiratory fitness in patients with morbid
obesity (n = 43) and established systolic dysfunction heart failure (n
= 235), and in age-matched medical control subjects (n = 222) who had
been referred for diagnostic exercise testing with simultaneous
metabolic measurements. Only patients who completed an adequate test
for maximum exertion manifested by a respiratory exchange ratio of >/=
1.10 were included in the study.
RESULTS: The mean (+/- SD) body mass index (BMI) values for the three
groups were 47.8 +/- 5.1, 30.1 +/- 5.7, and 33.8 +/- 9.0, respectively
(p < 0.0001 for comparisons between morbidly obese patients and each
comparator). The mean left ventricular ejection fraction for the heart
failure group was 21.5 +/- 8.4%. Despite achieving higher peak heart
rate and BP values, the morbidly obese patients had a mean maximum
oxygen uptake (Vo(2)max) that was similar to that of those with heart
failure (17.8 +/- 3.6 vs 16.5 +/- 5.6 mL/kg/min, respectively; p =
0.14) and was considerably lower than that of the control group (17.8
+/- 3.6 vs 21.3 +/- 8.2 mL/kg/min, respectively; p = 0.007). In
addition, among subjects in the control group, there was a graded
inverse relation between BMI and Vo(2)max.
CONCLUSIONS: Morbidly obese individuals have severely reduced
cardiorespiratory fitness that is similar to those with established
systolic dysfunction heart failure. In addition, in those persons who
are referred for stress testing for medical reasons, there is an
inverse graded relationship between BMI and cardiorespiratory fitness.
These data suggest that the impairment in Vo(2)max in morbidly obese
persons is related to BMI and possibly to other factors that impair
peak cardiac performance. These findings are consistent with overall
higher expected mortality in morbidly obese persons.
Chest. 2005 Jun;127(6):2197-203. Comparative Impact of Morbid Obesity
vs Heart Failure on Cardiorespiratory Fitness.Gallagher MJ, Franklin
BA, Ehrman JK, Keteyian SJ, Brawner CA, Dejong AT, McCullough
PA.Divisions of Cardiology, Nutrition, and Preventive Medicine, William
Beaumont Hospital, 4949 Coolidge Hwy, Royal Oak, MI 48073.
pmc975@yahoo.com.
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