ANSWERED QUESTIONS ON CARDIOVASCULAR DISEASE IN OBESE PEOPLE
How does this affect clinical practice?In practice, it is important to make an accurate assessment of cardiovascular risk by using, for instance, Framingham or Sheffield tables. However, obesity was not considered important enough by the Framingham investigators to be given the status of independent risk factor, although it was measured accurately during the study. This could be because of the relatively low prevalence of the condition when the study was conducted (in the mid- to late 1980s) compared with today’s epidemic. Whatever the reason, it does diminish the usefulness of the tables when considering the cardiovascular risk of an obese person. It is reassuring for doctor and patient alike to see the cardiac risk factors tumble as weight is reduced, and other parameters, for example, blood pressure and cholesterol, follow suit.
Is there a link between obesity and cardiac arrhythmias?There are various reasons why obesity can cause arrhythmias, including hypoxia, hypercapnia, coronary artery disease, sleep apnoea, myocardial hypertrophy and fatty infiltration of the conducting system.
What is the association between obesity and stroke?The incidence of stroke is increased in the presence of obesity, although the relationship is less clear than in the case of heart disease. It seems self-evident that the risk of stroke in obesity is increased because of the simultaneous presence of dyslipidaemia and hypertension, but it is an area that has not been closely studied. The Northern Manhattan Stroke Study concluded that abdominal obesity is an independent, potent risk factor for ischaemic stroke in all ethnic groups. A waist : hip ratio in the highest quartile was associated with a risk ratio of 3 (adjusted for other risk factors) in men and women of all ethnic groups, but the effect was most pronounced in young people.*3/312/5*
