The risk of heart attack and stroke is higher in young people who have been obese for more than a decade

Men under 65 and women under 50 who have been overweight or obese for 10 years are at increased risk of heart attacks and strokes, according to new research presented at the Endocrine Society's annual meeting, ENDO 2024.

For the study, which has not yet been published in a peer-reviewed journal, the researchers used data from the Nurses' Health Study and the Health Professionals Follow-Up Study. They analyzed health information on 109,259 women and 27,239 men with a body mass index (BMI) greater than 25, and looked at heart attacks and strokes between 2000 and 2020. There were 12,048 cardiovascular events recorded during the study.

In women under 50 and men under 65 who had been obese for 10 years or more, the researchers found the following:

• The risk of heart attack and stroke increased by 25-60%.
• No increased risk was observed in women over 50 years of age or men over 65 years of age.

Based on these data, the researchers concluded that the earlier a person begins treating obesity, the better for their cardiovascular health.

“Excess weight is harmful when it’s present for a long time,” said lead study author Dr. Andrew Turchin, director of quality in the division of endocrinology at Brigham & Women’s Hospital and an assistant professor of medicine at Harvard Medical School in Boston. “Preventing it — through early treatment of obesity — can prevent complications and improve outcomes for patients. These findings show health care professionals that early intervention is key to preventing obesity-related complications. Now that there are more options available to help overweight and obese people lose weight, health care professionals should be quick to offer these methods to their patients.”

The relationship between obesity and overall health

Dr. Sean Heffron, a cardiologist at NYU Langone Health in New York City, studies the link between heart health and obesity.

“This is a very important topic that I am currently researching,” said Heffron, who was not involved in the study. “Without access to the full study, it is difficult to draw definitive conclusions. However, it may be that in cases where the overall burden of obesity is lower, people are generally healthier and live to old age without other medical conditions.”

In a review article published in 2023, Heffron and colleagues described how the degree and duration of obesity affect health differently.

He detailed the conditions and the impact of obesity on them:

• Hypertension - the degree of obesity has a more significant impact than duration.
• Type 2 diabetes - the duration of obesity has a more significant impact than the degree.
• Dyslipidemia – the degree of obesity has a more significant impact than duration.
• Cardiovascular and all-cause mortality, atherosclerotic cardiovascular disease (ASCVD) and cardiomyopathy – both duration and extent are important.

“This new study looked at how obesity affected different age groups,” said Dr. Michelle Weinberg, a cardiologist at Providence Saint John’s Health Center in California, who was not involved in the study. “The middle age group had the highest risk. The younger group had a lower disease burden because they had been obese for a shorter period of time. The older group saw some protective benefits of being overweight. The middle group shows how a high BMI can negatively impact health.”

Obesity in old age

Older people have a lower risk of heart attacks and strokes linked to obesity than younger people, a new study shows.

This obesity paradox involves counterintuitive findings that while people who are overweight or obese have a higher risk of developing heart problems, once a person develops heart disease, those with a higher BMI are less likely to die than people of average weight.

Various explanations have been proposed, including the fact that once a person has developed heart problems, some excess weight may somehow protect against further health problems and death, especially since people with serious and chronic illnesses often lose weight.

"We've known for a long time that obesity is a risk factor for cardiovascular disease, so the results of the current study are not surprising," said Dr. Cheng-Han Chen, an interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in California.

Being overweight appears to offer protection in older people.

“This study is consistent with other studies that suggest that being overweight in later years may protect against certain diseases,” said Chen, who was not involved in the study. “It’s common knowledge that risk declines with age; older people with higher BMIs tend to have better cardiovascular outcomes. This may mean that being overweight reflects their robustness. They’re not frail and sick. We don’t know exactly why older people who are overweight are robust and healthy.”

"However, the study highlights the need to develop a heart-healthy lifestyle early in life. I tell my patients about the American Heart Association's Life's Essential 8, which provides a roadmap to better heart health. One of the points is maintaining a healthy weight and following healthy eating habits," Chen added.