Why are obese people susceptible to cardiovascular disease?

Associate Professor, Dr. Pham Nguyen Vinh, Director of the Cardiovascular Center, Tam Anh General Hospital, Ho Chi Minh City, explained that adipose tissue acts as an endocrine organ, releasing inflammatory substances (TNF-α, IL-6), damaging blood vessel walls, promoting atherosclerosis. This condition increases the risk of coronary artery disease, myocardial infarction, cerebrovascular disease and stroke.

Excess visceral fat also causes insulin resistance, leading to metabolic syndrome and type 2 diabetes – factors that increase cardiovascular risk. The 2010-2017 Multi-Ethnic Study of Atherosclerosis (MESA) of more than 93,200 people aged 45-79 years was published in Frontiers magazine shows that 80-90% of people with type 2 diabetes are overweight or obese, and obese people are nearly 3 times more likely to have heart disease than normal people.

Dyslipidemia in overweight and obese people is often manifested by increased triglycerides, decreased good cholesterol (HDL) and the appearance of many small, dense LDL particles – the type that can easily harm blood vessels. These changes cause fat to accumulate in the artery walls, forming atherosclerotic plaques, thereby increasing the risk of heart attack and stroke.

“In young people with non-ST elevation myocardial infarction (NSTEMI), overweight and obesity may be the most important risk factors, more than smoking,” said associate professor Vinh. The higher the BMI, the greater the risk of disease and the earlier it tends to occur.

Obesity easily leads to hypertension due to increased blood volume and cardiac output, activating the renin-angiotensin-aldosterone system (RAAS), causing blood pressure to remain high. In the long term, this pressure hardens and narrows the arteries, forming atherosclerosis, and causes the heart to work harder, the heart muscle thickens, increasing the risk of coronary artery disease, myocardial infarction, and heart failure.

Excess fat also causes the heart to pump harder, over time causing changes in heart structure and leading to heart failure. When high blood pressure is accompanied by dyslipidemia, cardiovascular disease progresses faster. In addition, obesity is also associated with atrial fibrillation due to changes in the structure and electrical signals of the heart.

Associate Professor Vinh cited the 2024 statistics of the European Society of Cardiology (ESC) showing that the obesity rate has more than doubled in the past 4 decades. At the Tam Anh General Hospital system in Ho Chi Minh City, the number of patients coming for examination and treatment of heart disease (hypertension, dyslipidemia, heart failure…) who are overweight or obese accounts for about 10-15%.

For example, Mr. Manh, 57 years old, weighing 118 kg, was hospitalized for treatment twice within 3 months. MSc.BS.CKII Huynh Thanh Kieu, Head of Cardiology Department 1, Tam Anh General Hospital, Ho Chi Minh City, said the patient suffered from many cardiovascular diseases including heart failure, atrial fibrillation, coronary artery disease, lipid disorders, and obstructive sleep apnea. “The age factor and highest obesity (BMI 40.35) are the main causes of this condition,” Dr. Kieu explained.

After a week of intensive medical treatment, symptoms improved. The doctor also prescribed medicine to help him lose weight, developed a suitable diet and exercise regimen and instructed him to have follow-up examinations on schedule.

Associate Professor Vinh said losing weight is an important measure to prevent cardiometabolic syndrome. By reducing 5-10% of body weight, patients can reduce triglycerides by 40 mg/dl, increase HDL cholesterol by 5 mg/dl, reduce systolic and diastolic blood pressure by 5 mmHg, reduce the risk of death from acute myocardial infarction or stroke by 21%, prevent the progression of type 2 diabetes…

To reduce cardiovascular risk, in addition to weight control, it is necessary to keep waist circumference <90 cm in men and <80 cm in women. Effective measures include lifestyle changes, medication, and surgery when needed. Dietary principles prioritize white meat (chicken, duck, fish, frog…), fiber, limit starch, avoid processed foods, drink 1.5-2 liters of water and maintain regular exercise.

Depending on each case, the doctor may prescribe weight loss medication, for example when BMI ≥ 30 or BMI ≥ 27 with a risk factor such as hypertension after at least 3 months of ineffective lifestyle changes. Asians (like Vietnam) can use the drug if BMI ≥ 25 with a risk factor such as hypertension. In cases of BMI ≥40 or ≥35 and disease, gastric surgery (Bari-surgery) can be considered.

Overweight people should be examined for advice on appropriate weight loss methods according to their physical condition and underlying diseases. Maintaining BMI 18.5-22.9 helps prevent cardiovascular disease effectively. Overweight or obese people who experience warning signs such as difficulty breathing, chest pain, dizziness, lightheadedness, abnormal heart rate, fatigue… should see a doctor immediately.