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Obese Patients More Likely to Receive Preventive Meds

CardioSmart News

Whether patients at high risk for heart attack and stroke receive the best possible medication is largely influenced by their weight, according to a study recently published in the European Heart Journal.

This study analyzed results of the REACH cohort, an international study that followed adults from around the world to learn more about risk factors and treatment for heart disease. The goal of this analysis was two-fold.

First, experts wanted to compare medication use among patients at high risk for heart events. Although medication can reduce cardiovascular risk in such patients, not all patients are prescribed the proper drugs or take these medications as they should. Researchers hoped to see how effectively patients were receiving the preventative treatment they need to reduce cardiovascular risk.

The second goal of the study was to determine whether differences in medication use could help explain the “obesity paradox.” The obesity paradox refers to a recent phenomenon where obesity is associated with better survival in certain groups of patients. For example, among those with heart failure and diabetes, obese individuals tend to live longer than patients that are a normal weight. Since obesity usually harms health rather than helps it, experts wonder what could explain this perplexing relationship. One theory is that obese patients have better outcomes because they use more preventative medications than other patients.

To learn more, researchers analyzed data from more than 54,000 patients enrolled in the REACH cohort. All patients were at high risk for a heart event, as they either had a past heart event (like heart attack or stroke) or had multiple risk factors for heart disease. In addition to collecting information on patients’ health and outcomes, researchers tracked medication use among participants. Investigators focused on four types of preventative medication including cholesterol-lowering statins, blood thinners and two kinds of blood-pressure lowering medications.

After following patients for up to four years, researchers noted a number of interesting findings. Overall, underweight patients had the highest risk for heart events and death while obese patients had the lowest. Not surprisingly, researchers also found that the more a patient weighed, the more likely they were to be on all four types of preventative medications. However, this difference in medication use did not explain the protective effect of obesity on cardiovascular health. In other words, preventative medication use is not the reason obese patients with high cardiovascular risk tend to live longer than underweight or normal weight patients.

This study provides yet more evidence of the obesity paradox and did not confirm a potential explanation for this phenomenon. It also highlights the need for more consistent use of preventative medications among patients with high cardiovascular risk. Although preventative medications are used widely in many countries, this study included patients from 44 countries across the globe. Authors note that overall use of preventative medication in this study was lower than usual, suggesting that certain countries may not use these medications as effectively as others. And since patients in this study are ideal candidates for preventative medication, it’s important that medications are used effectively in such high-risk patients. Combined with healthy lifestyle changes, medication is an important part of treatment for many patients at increased risk for heart events.

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