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SOME QUESTIONS ABOUT HEART ATTACK AND OBESITY
What Happens When We Gain and Lose Weight?
Weight gain is often the forerunner of high blood pressure. We know also, from the Framingham study that people who gain weight as adults tend to have a higher blood cholesterol than those who keep their weight steady. It is not clear whether this rise in cholesterol is due to weight gain itself, or to overeating particular foods. A very common cause of obesity in men (rarer in women) is over-indulgence in alcohol; this often increases the blood-fat (triglyceride) level.
What if one is already too fat?
Weight reduction tends to improve high blood pressure. It also reduces high blood-cholesterol and triglyceride levels. This is a valuable way of treating people in whom blood-cholesterol or triglyceride levels are raised. Drs Olefsky and Reaven in California have shown that the fall in blood cholesterol and triglyceride persisted after their patients had finished shedding some or all of their surplus weight. The benefit continued when they resumed a diet which kept their weights steady at a near-normal level.
A brilliant, successful and highly stressed television producer aged thirty-nine years sought a consultation because of pains in his chest. These proved to be due to angina, as shown by his ECG which was normal at rest but became abnormal during exercise. His father had died of a heart attack at the age of fifty. He was about 8 kg (17 lb) overweight, and had moderately high blood pressure. A blood test showed high blood-cholesterol and triglyceride levels.
A reducing diet was prescribed as the only treatment. He followed this with rather alarming enthusiasm. His blood pressure, cholesterol and triglyceride levels all became impeccably normal, and have remained so at three annual follow-up visits. During this period he has had only one further episode of angina.
In an overweight diabetic, the most effective treatment is to deal with the obesity. Adequate weight reduction very often abolishes the symptoms of diabetes, and the blood tests approach normal values too.
Does correction of obesity reduce the risk of having a heart attack? From the foregoing one might expect that it would. Dr Morrison has studied the effects of a weight-reducing, low-fat diet on men who have already had a heart attack. He reported a far lower relapse rate in those who followed the diet than in those who did not. But we are still far from certain about the benefits of weight reduction.
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