Obesity Complicates the Diagnosis and Treatment of Heart Disease

Highlights:

Excess fat skews test results leading to under- or overdiagnosis of heart disease
It impacts all cardiac diagnostic tests, including the ECG, CT scan, MRI, and echocardiogram
Therefore, it is critical to reduce overall weight to improve the prognosis of heart disease

Being overweight has a greater influence on your heart health than you may realise. A recent JACC review report from the Mayo Clinic describes how obesity affects standard tests used to diagnose heart disease as well as therapy options. Cardiovascular disease is the leading cause of death in the United States and around the world, but it is mainly avoidable.

Does Obesity Affect Health?

"Excess fat acts as a kind of filter and can skew test readings to under-or overdiagnosis," says senior author Francisco Lopez-Jimenez, M.D., director of preventive cardiology at Mayo Clinic. "Obesity affects nearly all the diagnostic tests used in cardiology, such as ECG, CT scan, MRI and echocardiogram."

Procedural procedures such as stent implantation through the leg or heart surgery may be more difficult to conduct in patients with severe obesity and may include additional risks such as an increased risk of infection at the incision site.

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‘Patients with heart disease and a very severe level of obesity, in general, will benefit from attempting lifestyle modifications. And if it does not work, or if they have tried it before, it is reasonable to think about bariatric surgery or drugs.’

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In obese patients, common pharmacological therapy for cardiovascular disease may need to be modified or down. Certain drugs, such as beta-blockers, may impair a patient's ability to lose weight, and Dr. Lopez-Jimenez emphasizes the significance of attempting alternate techniques to keep these patients from gaining weight or to assist them in losing weight.

Planning a Weight Loss Program in Obese Patients with Heart Disease

Suggestions to lose weight can be difficult to follow because heart patients have difficulty moving and may experience symptoms such as shortness of breath when exercising. These symptoms frequently dissuade patients from engaging in physical activity, but Dr. Lopez-Jimenez emphasizes the importance of exercise not only for weight loss but also for heart health.

"Obesity is an important risk factor to address in patients with heart disease and it requires us to do something," says Dr. Lopez-Jimenez." The patient needs to know that their clinician can help them lose weight. Overall, weight loss solutions come down to finding the right therapy for the patient."

A typical weight loss program will include a therapist, a dietician, and possibly a psychologist. If that isn't enough, Dr. Lopez-Jimenez adds there are additional options, such as bariatric surgery and drugs, that can help patients lose weight. The Mayo Clinic recently launched a comprehensive cardiometabolic program to combat obesity, minimize linked illness conditions, and assist patients in improving their quality of life.

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It is critical to accurately define a person's level of obesity. BMI, a measure of body fat based on height and weight, has long been used to determine the degree of obesity. Those with a lot of muscle, on the other hand, will have a high BMI. Individuals with minimal muscle mass and much waistline fat may have a low BMI but be overweight. Waist-to-hip ratio and waist circumference measurements provide a more accurate estimate of cardiovascular risk.

"In general, patients with heart disease and a particularly advanced degree of obesity will benefit from trying lifestyle modification. And if that doesn’t work, or if they have tried that in the past, it is reasonable to consider bariatric surgery or medications," says Dr. Lopez-Jimenez.

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