Sunday, December 9, 2018

Central obesity is very prevalent in persons at high risk of heart disease and stroke

Results of the European Society of Cardiology (ESC) EUROASPIRE V survey presented yesterday at the World Congress of Cardiology & Cardiovascular Health in Dubai, UAE show that almost two-thirds of people at high risk of heart disease and stroke have excess belly fat or central obesity. EUROASPIRE is a series of cross sectional surveys on the prevention of heart disease in ESC member countries.

The survey found that almost two-thirds (64%) were centrally obese, with waist circumference ≥88 cm for women and ≥102 cm for men). Some 37% were overweight (body mass index [BMI] 25-29.9 kg/m2) and 44% were obese (BMI ≥30kg/m2 ).

Less than half (47%) of those on antihypertensive medication achieved the target BP of less than 140/90 mmHg (less than 140/85 mmHg in patients with self-reported diabetes). And, only 43% of the participants on lipid-lowering drugs attained the LDL cholesterol target of less than 2.5 mmol/L, while 65% of those being treated for type 2 diabetes achieved the A1c target of less than <7.0%.

About 18% were smokers and just 36% achieved the recommended physical activity level of at least 30 minutes, five times per week.

The EUROASPIRE V was conducted in 2017 to 2018 in 78 general practices in 16 primarily European countries and involved 2,759 participants. Each general practice enrolled consecutive individuals under the age of 80 years with no history of coronary artery disease or other atherosclerotic disease, but who were at high risk of developing CVD. High risk was defined as having high BP, high cholesterol, and/or diabetes; the study therefore recruited individuals who had been prescribed antihypertensive, lipid-lowering, and/or anti-diabetes treatments (diet and/or oral hypoglycemics and/or insulin).

BMI is generally used as a measure of obesity. It takes into consideration height and body weight, but not body fat.

A correct measure of obesity therefore is via measurement of body fat, especially the fat around the abdomen. A high waist-to-hip ratio indicates high amounts of abdominal fat. A person can be obese even if the body weight is within the normal range. This is called normal weight obesity, where the BMI is normal as per the age and height, but the body fat percentage is high. Typically, such individuals have a potbelly but otherwise appear normal. Abdominal obesity is more dangerous than generalized obesity.

Any weight gain after puberty is invariably due to fat as most organs also stop growing, once the height stops increasing. One should not gain weight of more than 5 kg after the age of 20 years in males and 18 years in females. And, after the age of 50, the weight should reduce and not increase.

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA

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