Obesity After Heart Attack Carries Vastly Different Risks Depending on Diabetes
A Swedish study of 124,000 heart attack patients reveals that obesity's danger varies dramatically by diabetes status. Obese patients with diabetes face twice the risk of death or major cardiac events, while obese patients without diabetes face substantially lower risks—challenging one-size-fits-all treatment approaches and suggesting cardiologists need individualized risk assessment protocols.
Originaltitel: Obesity and Cardiovascular Outcomes After Myocardial Infarction - a nationwide SWEDEHEART analysis by diabetes status.
Högt kardiovaskulär risk efter hjärtinfarkt kombinerat med fetma och diabetes kräver omedelbar fokusering från inköpschefer och klinik-ledning. En analys av över 124 000 hjärtinfarktpatienter från SWEDEHEART-registret visar att 21 procent hade diabetes, varav 37 procent var fetma jämfört med 20 procent utan diabetes. Patienter med svår fetma och diabetes uppvisade två gånger högre dödlighet och kardiovaskulär risk än normalviktiga utan diabetes. Risken för hjärtsvikt och njurskador var ännu mer uttalad — 2,9–3,4 gånger högre i denna grupp. Utan diabetes krävdes högre fetmagrado för ökad risk. Forskarna från Karolinska Institutet och Uppsala universitet identifierar således en kritisk patientgrupp som behöver målriktad övervaknings- och interventionsstrategi. Resultaten påverkar sjukvårdsplanering och prioritering av preventiva behandlingsprotokoll för denna högriskpopulation.
AIMS: To analyse the prevalence of obesity and its impact on long-term cardiovascular outcomes in patients with myocardial infarction (MI). METHODS: Patients with MI registered in SWEDEHEART between 2010 and 2021 were followed through December 2021 (mean follow-up time 6 years). Associated risk of adverse events in WHO Body mass index (BMI) strata was assessed in adjusted Cox proportional hazards models, stratified by diabetes status (reference: normal BMI without diabetes). RESULTS: Of 124 360 patients, 21% had diabetes. Obesity was more common among patients with diabetes (37% vs. 20%). The highest risk of mortality and major cardiovascular events (MACE; all-cause death, MI, stroke, or heart failure) was observed in those with class 3 obesity and diabetes (HR 2.15 [95% CI 1.88-2.45] and 1.91 [1.73-2.10]), with a lower risk of MACE in class 3 obesity alone (1.29; 1.16-1.45). In patients without diabetes, the risk of MACE and death was present in class 2 and class 3 obesity, but not in those with overweight or class 1 obesity. Regardless of diabetes status, obesity was less associated with atherosclerotic events than heart failure and renal events. The highest risk for heart failure and renal events was for class 3 obesity with diabetes (2.92 [2.57-3.31] and 3.36 [2.87-3.93]). CONCLUSION: In patients with myocardial infarction, obesity is common and associated with a high risk of mortality, heart failure, and renal events, especially if diabetes is present. There is a need for an increased awareness of this high-risk group with obesity and cardiovascular disease.