In Mexican-Americans, problems with cholesterol, blood sugar and blood pressure are better predictors of artery disease than excess weight, a new study finds. Researchers measured all of these factors, and others, among 503 Mexican-American adults. Their average age was about 50. They also gave everyone carotid ultrasound tests. This test can detect atherosclerosis (plaque) in the arteries of the neck. Usually that means someone has plaque inside other arteries as well.
This can lead to heart attack and stroke. About 78% of those in the study were found to be metabolically unhealthy. This means they had at least 2 of the following problems: insulin resistance (which can lead to high blood sugar) or already high levels of blood pressure, blood sugar, cholesterol, triglycerides or C-reactive protein. About half of those in the study were obese. About one-third had plaque in their carotid arteries, as shown by ultrasound. Rates were higher among those in poor metabolic health. And those who were not obese were just as likely to have plaque as those who were obese. The Journal of the American Heart Association published the study. Medical News Today wrote about it March 18.
By Robert H. Shmerling, M.D.
What Is the Doctor's Reaction?
You've likely heard plenty about the rising rates of obesity. Considering the health risks linked with increased weight, you might think that losing excess weight should be a major priority. And you'd be right.
But a new study suggests that, in some situations, weight loss should not be the primary focus. It appears that, for some people, blood sugar, cholesterol and blood pressure levels can be more important than weight loss.
The study included more than 500 Mexican-American adults. Researchers examined the relationships among three types of health factors:
- Body mass index (BMI, a measure of weight that accounts for height)
- "Cardiometabolic risk factors" (including a blood sugar, cholesterol levels and blood pressure)
- Atherosclerosis, the "hardening of the arteries" that often leads to a heart attack or stroke
In this study, no one had a history of heart and blood vessel disease. Atherosclerosis was detected by an ultrasound test of the carotid artery, a major artery in the neck. This test can detect the problem well before any symptoms develop.
This study found that:
- Nearly 80% of those in the study had unhealthy metabolic risk factors. They were more common among people who were:
- Less educated
- Eating fewer fruits and vegetables than recommended
- About one-third of those in the study had signs of atherosclerosis, shown by the carotid ultrasound tests.
- Metabolic risk factors were linked with a greater likelihood of atherosclerosis. BMI was not.
These results suggest that when it comes to the risk of heart disease and stroke, it may be more important for some people to improve metabolic factors than to lose excess weight. And this might be more common among members of certain ethnic groups.
But weight loss may still be important. After all, obesity increases the risk of many metabolic problems. And those problems increase the risk of heart and blood vessel disease. Perhaps that's why only 10% of the obese individuals in this study had healthy metabolic profiles.
Obesity also has harmful health effects other than atherosclerosis. For instance, it can increase the risk of arthritis, depression and certain types of cancer (to name a few).
What Changes Can I Make Now?
In my view, it seems a bit artificial to emphasize metabolic risk factors over body mass index. After all, both are so tightly connected to health. Both have profound effects on several health risks, not just atherosclerosis. And we don't know which risk factor (or combination of risk factors) is the most important in any single person.
So the findings of this study will not change what I say to my patients. It's important to maintain a healthy weight. And it's also important to do what you can to keep your cholesterol, blood sugar and blood pressure in healthy ranges.
You can make several changes to help accomplish this:
- Get more active. Try to exercise for 45 minutes a day at a moderate intensity most days of the week. Increase your "non-exercise" activity as well. Take the stairs. Walk more.
- Know your blood pressure and blood lipid levels (including your total, HDL and LDL cholesterol results). If they are not in ideal ranges, talk to your doctor. Lifestyle changes and, if necessary, medicines can improve these results.
- Ask your doctor if you should be screened for diabetes. This may be particularly important if you are obese or if you have a family history or symptoms of diabetes (such as frequent urination).
- Know your BMI. Do what you can to avoid obesity (a BMI of 30 or higher). Considering how difficult it can be to lose weight, it's important to avoid excessive weight gain in the first place.
- If you do need to lose excess weight, talk to your doctor about a diet and exercise program. An organized weight loss program (such as Weight Watchers) can be helpful. Medicines and surgery are occasionally recommended.
Take all your medicines as prescribed at online pharmacy. For people who already have heart and blood vessel disease, preventing further problems is possible with lifestyle changes and medicines.
What Can I Expect Looking to the Future?
The impact of excess weight will continue to impose an enormous public health challenge for decades to come. But I hope that the attention given to the epidemic of obesity will lead us to make changes. If we improve our diets and get more active, we may be able to live at healthier weights.
These changes should reverse the rise in obesity rates. But they are also the cornerstones of better metabolic health.
Last updated March 19, 2015