Fatties do better after heart attacks

Cardiac Rehabilitation Clinic

Some doctors will admit to a little schadenfreude that health freakery does not confer cardiac invulnerability. There is nothing more depressing for the family doctor than trying to advise a slim, trim, lycra clad, non-smoking, gym-visiting middle-aged vegetarian, who has just has his first heart attack, on life style changes.

So much easier to help the flabby lounge lizard who is three stone overweight and has not taken exercise since TV remote controls were invented.

Now we hear that fatties who have heart attacks may have a better prognosis than the the health freaks. Various theories are suggested.

(The) differences in body chemistry caused by obesity might play a role. For instance, levels of blood platelets, which can affect clotting, are lower in obese patients, while levels of fat in the heart tissue, which might have a protective effect, are higher. Another theory is that the higher levels of endogenous cannabinoids in obese people might be key. There is a growing body of evidence to suggest that these chemicals have a protective effect during a heart attack. (BBC)

Counter intuitive research findings like this are a constant source of pleasure. But I shall not be rushing to put all my post-heart attack patients on a diet of Mars Bars and McDonalds.

Why do fatties seem to do better? I am not sure I buy into any of the chemical theories advanced above.The truth is probably more mundane.

The life time risk of heart attack is predominantly a function of the hand of cards you are dealt at birth. The fatties may have been lower risk at birth, but have brought the disease prematurely upon themselves. The thinnies were probably always high risk and, had they not looked after themselves, would probably have had their heart attack even sooner. Given that they were high risk from the beginning, and already have excellent lifestyles, there is not much more they can do but keep their fingers crossed.