Obesity a Factor for Heart Failure

More than 13,000 people has found that even after accounting for such risk factors as high blood pressure, high cholesterol and diabetes, so-called morbid obesity appears to stand alone as a standout risk for heart failure, but not for other major types of heart disease.

In a report on the research, published online on July 28 in the Journal of the American Heart Association, says morbidly obese individuals were more than two times more likely to have heart failure than comparable people with a healthy body mass index, after accounting for high blood pressure, cholesterol and blood sugar levels. And yet, after accounting for these factors, people with morbid obesity weren’t any more likely to have a stroke or coronary heart disease — basically disease of the heart’s arteries,” due in part to inflammation and an accumulation of plaque in the heart and surrounding blood vessels.

The researchers caution that their study suggests a strong, independent link between severe obesity and heart failure but does not definitively determine cause and effect.

Nevertheless, they say, their findings suggest that while treating hypertension, diabetes and other conditions associated with obesity may be sufficient to prevent coronary heart disease and stroke, this approach may not be enough to prevent an increased risk of heart failure, for which weight loss may be the only foolproof, currently available preventive measure. The federal government estimates that one in three Americans is obese and more than 5 percent are morbidly obese — defined as a body mass index of greater than 35. According to the U.S. Centers for Disease Control and Prevention, almost 6 million people in the United States are living with heart failure, a condition of aging marked by enlarged and/or weakened heart muscle and diminished blood-pumping efficiency, resulting in shortness of breath, fatigue, weakness, trouble breathing when lying down, and swelling in the ankles and feet. Overall, there is a 50 percent mortality rate for people with heart failure five years after diagnosis.

Obesity in our study has emerged as one of the least explained and likely most challenging risk factors for heart failure because there is no magic pill to treat it, no drugs that can easily address the problem like there are for high cholesterol and high blood pressure, “Even with diet and exercise, people struggle to lose weight and keep it off, and for the morbidly obese, the struggle is often insurmountable.

Although it isn’t completely clear why obesity alone is linked to heart failure independent of risk factors and not to stroke or coronary heart disease, there is evidence to suggest that extra body weight exerts a higher metabolic demand on the heart and that fat cells in the abdomen may even release molecules toxic to heart cells.

Obesity has long been known to increase the likelihood of high blood pressure, elevated blood cholesterol and diabetes — all established risk factors for heart and blood vessel diseases. Treating and controlling these conditions have formed the bedrock strategies for reducing the risk of cardiovascular disease.

To learn if this was truly the case for all types of cardiovascular disease, researchers looked at the medical records of 13,730 participants  in the Atherosclerosis Risk in Communities Study who had body mass indexes in healthy ranges or higher at the start of the study and no initial heart disease. The group was composed of 63.8 percent women and 16.9 percent African-Americans. The average age was 54, and body mass index ranged from 18 to 50. All were followed for approximately 23 years to assess links between body mass index and heart failure, coronary heart disease or stroke.

The records also included data for participants’ height, weight, and levels of blood sugar, cholesterol and triglycerides, along with smoking status, alcohol use, professions and exercise levels.

After the final participant follow-up in 2012, there were 2,235 recorded cases of heart failure, 1,653 cases of coronary heart disease and 986 strokes.

In their initial assessment, the Johns Hopkins researchers controlled for differences that might be due to age, sex, race, education level, career, smoking history, exercise and alcohol consumption. Severe obesity was associated with a nearly fourfold higher risk of heart failure and about a twofold higher risk for both coronary heart disease and stroke compared with rates for those with a normal body mass index.

Next, the researchers controlled for other heart disease risk factors, such as diabetes, high blood pressure, or high levels of cholesterol and triglycerides. After this adjustment, Ndumele’s team no longer saw an increase in risk for coronary heart disease or stroke in people with obesity. However, the increased risk for heart failure remained. For every five-unit higher body mass index, there was an almost 30 percent higher risk of developing heart failure across all participants. 

Even if the patients have normal blood sugar, cholesterol and blood pressure levels, it may still develop heart failure if they are severely obese. We need to improve our strategies for heart failure prevention in this population.

People with Disabilities Can Learn CPR

Learning high-quality CPR can be difficult for those people with disabilities even to a non-disabled people. Doing compressions at a rate of 100-120 BPM, having the strength to push down 2 inches in an adult victim, the endurance to provide CPR for minutes on end, and the ability to kneel for a long period of time. These are all challenges to overcome when learning CPR and it’s the job of the instructor to help students find the strength to overcome these challenges.

But what happens when your student is disabled? What if they are pregnant? Or deaf? Or missing a limb? Or do they simply have bad knees? How do you teach a student CPR who may not believe it is possible themselves? Thankfully, all it takes to save a life using CPR is a willingness to learn and an instructor who is willing to help students adapt to challenges they may face.

Training centers adapt to teach the disabled

Currently, CPR certification is given to students who can properly perform high-quality CPR and accurately use an AED. This means chest compressions of 100 – 120 BPM, a compression depth of 2 inches on adults and a 1/3 of the chest diameter in children, a chest compression fraction of greater than 80%, and no excessive ventilations, according to the American Heart Association. You also must understand how to properly use an AED to shock and revive a victim.

Unfortunately, some people with disabilities may not be able to properly learn and/or perform CPR in the intended way to earn that certification. However, that doesn’t mean there is no hope. Instructors can – and should – adapt their teaching methods to fit the needs of all of their students.

“There is nothing that you cannot modify to make [CPR training] capable for someone to be empowered to do this,” said Tammy Turner, the National Training Center Coordinator, an American Heart Association Training Center, since 2014 and an instructor since 1996.

“You have to have a different way to teach someone who is deaf…someone who is blind are not going to see the visual aspect, but you can paint pictures in their mind. They’re very capable. Also, have CPR training be something they can physically feel.”

Even if someone can’t physically perform the requirements, they can still understand the concepts of CPR. Leadership during an emergency is just as important as those doing the ‘heavy lifting.’ The American Heart Association understands and will grant an Advisor: BLS CPR card to those who perform verbal recognition of the required knowledge and skills for CPR.

Students with disabilities may have some limitations, but many can overcome these potential limitations with technology and creative thinking.

When it comes to technology, accessibility is becoming more important than ever. Large companies like Google, Yahoo, Apple, and others are leading the way to make technology more accessible for those with disabilities, such as smartphone screen magnification or eye tracking for those who are paralyzed

First Support CPR offers CPR classes every Tuesday at 7:15 PM. We offer BLS, First Aid, CPR AED, First Aid CPR AED and Pediatric First Aid CPR AED. We also offer an offsite training. If you have any questions, you can email us at info@firstsupportcpr.com or call at ‪(408) 475-7724‬.