The well-trained bariatric surgeons and cardiologists work in collaboration to evaluate patients with heart diseases caused by obesity and determine the most successful, individualized treatment approach. Our bariatric surgeons are highly skilled in performing complex surgeries to achieve weight loss. Apart from this, they also stress the need for lifestyle modifications in avoiding obesity as well as to reduce the risk of associated heart problems.
Obesity is a chronic metabolic disorder that is highly prevalent throughout the world. More than one-third of adults and one-sixth of adolescent children in the US are obese, according to the statistical data published by the Center for Disease Control and Prevention (CDC) in 2012. Obesity is associated with comorbid conditions including different forms of heart diseases.
Heart diseases are disorders that can hamper the normal functioning of the heart and are most commonly caused by the narrowing of the coronary arteries that provide blood supply to the heart. Excessive body fat, especially abdominal or central obesity increases your risk of developing heart disease significantly. If you are overweight or obese, you may develop conditions such as atherosclerosis and hypertension, which can lead to a higher risk of cardiovascular disease.
The relationship between your height and weight is a measure called the Body Mass Index (BMI), which is derived by dividing your weight in kilograms by the square of your height expressed in meters.
As your BMI increases, your risk for heart disease becomes higher. If your BMI is above 25, you are overweight, and your heart health may get adversely affected. You are considered to be obese and at a serious risk of heart disease if your BMI is more than 30. The fat cells get deposited in the tissues of your heart such as the atrioventricular node, sinus node, right bundle branch, and the myocardium. This can cause defects in conduction such as sinoatrial block, bundle branch block, and atrioventricular block in rare cases. These fat cells will secrete adipokines, which are locally active molecules that damage the contiguous myocardial cells.
Bariatric surgery or weight loss surgery can achieve a significant reduction in body weight that leads to decreased blood volume and resting metabolic demand. With this, blood pressure is lowered and the workload of the heart is likely to be less. Weight loss may interfere with advancing left-ventricular hypertrophy, and can help in its reversal. Bariatric surgery is relatively safe and effective even in patients with pre-existing heart diseases.
The Food and Drug Administration had recommended certain weight-loss surgical techniques as an effective treatment method for severe obesity. Weight-loss surgery involves decreasing the size of your stomach so that you feel full quickly, which helps you eat smaller portions and lose excess fat. Gastric bypass surgery works by blocking the absorption of few calories by your body.
There have been profound improvements in weight, blood pressure, lipid profile, with a reduced need for medicines in obese patients treated with a Roux-en-Y procedure. As your weight reduces, your blood pressure, cholesterol levels, diabetes symptoms, and other health problems associated with excessive weight get resolved. Thus, surgery to tackle excess body weight leads to sustained weight reduction for a long-term along with effective management of high cholesterol, diabetes, and high blood pressure.
The therapies useful in weight management include diet, physical activity, and pharmacotherapy. Behavior modification that helps with diet and activity is a significant aspect of all these therapies. In excessively obese people, even about 10% of weight loss is beneficial as it reduces stress on the heart and prevents risk factors of cardiovascular disease associated with obesity.
Obesity can lead to a variety of cardiac problems.
Obesity has a profound influence on your cardiovascular system, and may contribute to the development of signs of heart failure, coronary heart disease, stroke, arrhythmias, especially atrial fibrillation, and venous thromboembolism.
A common sign of severe obesity are swollen legs, which occur due to the structural and functional effects of excess body weight on your heart. In obese people, leg swelling may further lead to decreased movements and reduced blood flow in the veins of the legs. A sluggish flow of blood in the veins may give rise to leg ulcers and infections of the skin.
In severely obese patients, clinical evaluation of heart failure or other disorders may become difficult for reasons such as the inability of hearing heart and breath sound as these are distant, neck veins can hardly be seen, and the liver enlargement, even if present cannot be felt accurately. The following diagnostic tests may be done, but some of these may have limitations.
An EKG is a simple, painless test that can detect signs of damage to your heart, such as previous or current heart attack. It detects as well as records the rhythm and rate of your heartbeat. Severe obesity tends to modify the EKG results due to the interaction of factors such as an increased distance between your heart and the electrodes, a horizontally displaced heart because of raised diaphragm, enlarged heart, and other coexistent conditions such as sleep apnea.
During the stress test, pictures of the heart are taken while you exercise and at rest. The imaging stress tests can show how well your heart can pump the blood and the way it is circulated in your heart. Resting EKG abnormalities caused by obesity and difficulty in doing exercises may limit the use of stress testing in obese people.
Echocardiography uses sound waves to develop an image of the heart that reveals the size and function of valves of the heart. It can also distinguish areas of the heart that are receiving lesser blood supply, heart muscles that do not contract in a proper way, and any past damage to the heart muscle due to poor blood supply. In obese people, poor quality images are a common problem and techniques such as tissue Doppler or pulmonary venous Doppler can be more clear and accurate.
Chest X- Ray
A chest x-ray may be done to check for signs of heart failure and lung disorders.
Blood tests are done to measure the levels of cholesterol, sugar, and proteins in your blood. An elevated level of these indicates a risk for heart disease.
Obesity, on its own, is a risk factor for heart diseases as it affects the structure as well as functions of your heart. Obesity can affect your heart through risk factors, namely:
Modifiable risk factors: These risk factors increase your chances of developing heart problems and are affected by the amount of your body weight lost or gained.
Other modifiable risk factors include inactive lifestyle and smoking.
Non-modifiable risk factors: These risk factors cannot be changed by anybody, and these include age, family history, and racial background. Males older than 45 and females above 55 are at a higher risk of heart disease. People with a history of an early heart attack in their family members are at a higher risk of developing heart disease. Other non-modifiable risk factors include obstructive sleep apnea and inflammation.
Obesity can lead to heart diseases in several ways. This mechanism is indirectly mediated through certain risk factors that are associated with metabolic syndrome, which includes hypertension, dyslipidemia, glucose intolerance, and effects of sleep disorders associated with obesity. Metabolic syndrome is often accompanied with central or abdominal obesity (fat deposition in the abdominal region rather than the extremities). The fat, particularly the abdominal fat substantially affects your metabolism, for instance, your blood pressure and blood lipid levels get affected, and also your capability to make use of insulin effectively. Insulin is useful in glucose breakdown, but when you are unable to use insulin in an effective manner, you may develop increased blood glucose levels or diabetes, which is a risk factor for cardiovascular diseases.
Moreover, in abdominal obesity, the level of various inflammatory markers is increased and a prothrombotic state develops. Various adipokines and chemical mediators such as interleukin-6, tumor necrosis factor-a, plasminogen activator inhibitor-1, resistin, leptin, lipoprotein lipase, estrogens, and insulin-like growth factor-1 are present in elevated levels in obese patients. These factors can adversely affect your cardiovascular system by developing a prothrombotic and proinflammatory state. Additionally, these may lead to vascular hypertrophy and endothelial damage. The higher incidence of sleep apnea/hypoventilation syndrome in obese people may also affect the heart.
Apart from the conventional treatment methods, our patients are encouraged to seek alternative therapies before we decide to take up surgical means of treatment. Alternative treatments useful for cardiovascular health include:
Chiropractic care includes a non-invasive, natural treatment method that aids in the management of heart disorders. It can also prevent the occurrence of heart problems. Chiropractic adjustments along with lifestyle changes such as a healthy diet and increased physical activity can be helpful in bringing the cholesterol and triglyceride levels back to normal.
To maintain a healthy heart, it is advised to perform at least 30 minutes of moderate-intensity aerobic exercises for 5 days in a week or at least 25 minutes of vigorous aerobic activity for 3 days in a week. Moderate to high-intensity muscle strengthening exercises, when performed for at least 2 days a week helps in achieving additional health benefits.
Yoga basically involves stretching of your body into different poses (asanas) while you focus on your breathing. Practicing Yoga-based exercises can help you prevent or sometimes reverse your heart diseases. Yoga helps in relaxing your body as well as managing stress and anxiety effectively. You can expect great benefits with Yoga, however, it may not be possible to cure the disease.
Although certain risk factors such as your age, gender, family medical history cannot be changed, several lifestyle changes including diet and exercise along with medicines in few cases can control modifiable risk factors. Improving your lifestyle may include routine exercise and eating heart-healthy foods low in fat and sugar. It also requires quitting smoking, effective stress management, maintaining your blood lipid levels low, and taking appropriate treatment for high blood pressure or any other heart conditions that may aggravate your risk.
If you want to lose your excess weight and reduce your risk of heart disease, weight loss surgery might help in overcoming your problem of obesity. Feel free to consult our doctors at Marina Weight Loss if you have questions and want to discuss your treatment options.
Jeremy Korman, M.D., F.A.C.S.See Profile »
Mona Misra, M.D., FRCSC, FACS, FASMBSSee Profile »
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