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School of Medicine
Weight: A Silent Heart Risk
A recent, eye-opening study finds that much of the cardiovascular disease seen in severely overweight people is driven by more than diabetes and high blood pressure. Learn the new risk Johns Hopkins researchers now know obesity holds.
It’s long been known that when you’re overweight, you’re more apt to develop conditions like high blood pressure or diabetes that can lead to heart disease. Now Johns Hopkins researchers have shown that excess weight is more than an “accomplice” in the development of heart problems. The pounds themselves can cause heart muscle injury.
“Basically, being obese seems to be a ‘solo player’ associated with heart injury—that is, regardless of high blood pressure, elevated cholesterol and diabetes,” says Johns Hopkins cardiologist Chiadi Ndumele, M.D., M.H.S. “Down the road, this can lead to heart failure.”
The Weight–Heart Failure Connection
Heart failure is the organ’s inability to keep up efficiently with the demands placed on it. And it’s becoming more and more common, Ndumele says. “Lots of factors can cause heart failure, and the obesity epidemic is likely a contributor,” he says. By 2030, one in five adults may have heart failure.
It’s new thinking that obesity itself can lead to heart failure—even in the absence of known markers for heart disease, such as high blood pressure, diabetes and elevated cholesterol.
How Doctors Know the Obesity Risk
Injured heart muscle cells release an enzyme called troponin T. Doctors measure this in the blood when someone is suspected of having a heart attack. Now new, highly sensitive lab tests can measure troponin at much lower levels.
This development enabled Johns Hopkins researchers to measure the troponin levels as well as body mass index (BMI) in more than 9,500 adults, ages 53 to 73, who were free of heart disease.
They found that higher BMI was strongly linked to higher troponin levels. Over 12 years, those who were the most obese (BMI of 35 or higher) developed the most heart failure. So did those who had the highest levels of troponin. And those who were both the most obese and had high troponin levels were nine times more likely to develop heart failure than those who had normal weight and undetectable troponin, the researchers reported in a study published in the Journal of the American College of Cardiology: Heart Failure.
Even being somewhat overweight put people at higher risk, says Ndumele, the study’s lead investigator. And the more extra weight, the more risk, a connection that was very clear for the obese and very obese.
Watch Weight, Lower Heart Risk
Patients and doctors alike often think “everything’s OK” in the absence of diabetes or hypertension. “But there may be silent heart injury going on,” says Ndumele. Take extra pounds seriously with these steps.
- Try to lose weight (if overweight) or control weight. “That’s one of the best strategies we now know of to reduce heart failure down the road,” Ndumele says.
- Know your heart disease risk. It’s smart to have your heart risk assessed and “know your numbers” (BMI, blood pressure, blood sugar, cholesterol).
- If you’re obese, be watchful for signs of heart failure. These include fatigue, shortness of breath and an irregular heartbeat.
- Realize that all weight loss helps. For every five-point increase in BMI, the risk of heart failure rose by 32 percent in the study.