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By Jennifer J Brown, PhD


The elevated body mass index (BMI) in overweight and obese people isn't just linked to heart failure, it actually causes heart failure, finds a major new genetic study.


Normal BMI is from 18 to 25. But for every one-point increase in BMI over 25, the incidence of heart failure goes up 17 percent in overweight people, according to the large-scale, international study of 200,000 people. This calculation means an estimated 113,000 new cases of heart failure yearly in the United States for each one-unit increase in BMI.




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The international research project brought together 35 studies and more than 130 authors from the ENGAGE (European Network for Genetic and Genomic Epidemiology) Consortium, led by Dr. Tove Fall of the Karolinska Institute in Uppsala Sweden in collaboration with Oxford University in the United Kingdom. Published today in PLOS Medicine, the research sheds new light on causes of cardiovascular disease, currently the No. 1 killer in the United States.


"We know now that increased adiposity [fat] in itself is dangerous to the heart," said study investigator Dr. Fall. Before, researchers knew there was a link, but couldn't find a direct cause-and-effect relationship.


The relationship has to do with connections to the human gene for obesity, known as FTO (fat-mass and obesity-associated gene) which makes people susceptible to obesity and has to do with appetite. The FTO gene accounts for a third of all the variation we see in people's weights as increased BMI. Scientists observed that if you have one copy of the gene, you weigh more than if you have no copies, and if you have two copies of the gene, weight is even higher in large population studies. Now, increased BMI is connected to 24 cardio-metabolic traits related to heart diseases, in this new study.


Researchers found that higher BMI in overweight and obese patients actually caused heart failure, possibly due to increased blood pressure and stress on the heart organ. Elevated BMI also caused higher than normal levels of liver enzymes that indicate fatty liver disease. In addition, high BMI was linked to:


- Heart failure

- Stroke

- Hypertension

- Dyslipidemia (high cholesterol)

- Metabolic syndrome (a precursor to diabetes)

- Type 2 diabetes

- Higher risk for death


This is particularly concerning because obesity is on the rise around the world.


"This large study provides a more direct link to heart disease using genetic information," said Stephanie Moore, MD, a cardiologist at the Massachusetts General Hospital (MGH) Institute for Heart, Vascular and Stroke Care's Heart Failure and Cardiac Transplant Program in Boston.


Take Control of Your Jean Size, Not Your Genes


While this has established the relationship between overweight and heart disease, it leaves an important question for future studies -- whether losing weight will reverse a heart condition. "If we normalize our BMI," said Dr. Moore, "we have less cardiac risk factors like diabetes, high blood pressure."


While most experts agree that reducing risk factors should translate into fewer cases of heart disease, Moore was more cautious. "We would have to follow these patients in this study longitudinally, or over time, to truly prove that reducing your BMI with genetic predisposition decreases risk," she said.


Dr. Moore counsels her patients about their genetics and taking control over their weight. "I do tell my patients, you can't change your genes, but you can change your jeans size," said Moore.


To find your own BMI, divide your body weight by your height, using our BMI calculator.


According to study investigator Fall, "This is important, because this means that targeting an optimal BMI through various strategies will reduce the risk of having heart failure."


Fall points out that there is more to be done, to answer the question of whether weight loss will impact the heart directly. "We only studied the effect of adiposity [fat] on a population level," he said.


But, he added, "However, since we know that weight loss will improve many of the CVD [cardiovascular disease] risk factors and decrease the workload on the heart, it is very plausible that weight loss will decrease the risk of CVD."


"The most important prescription I can't write is for weight loss," said Moore -- acknowledging that weight loss is challenging for both physicians and patients.


What can you do to bring your BMI into a healthy range if it's not?


"I refer patients routinely for weight reduction surgery or weight loss programs," said Moore. A healthy diet plays an important role in heart health too. "Vegetables, lean meats, fruit and daily exercise are the best bet to avoid heart disease," she added.


"Bad News if Your BMI Is High: Fat Causes Heart Failure" originally appeared on Everyday Health.


Also on HuffPost:






  • Processed Meat


    Hot dogs, bacon, sausage and deli meats -- even lean ones like turkey -- are made with <a href="http://www.health.harvard.edu/healthbeat/avoid-these-foods-for-a-healthier-heart">loads of sodium and preservatives</a>, often including nitrates and nitrites, both of which have been linked to heart problems. "With processing, you lose control over the quality of the ingredients," says <a href="http://drcynthia.com/dr-cynthia/">Cynthia Thaik, M.D.</a>, a Los Angeles-based cardiologist. Processed meats are also <a href="http://www.huffingtonpost.com/david-katz-md/nutrition-advice-the-trut_b_584758.html">higher in saturated fat and lower in protein</a> than any red meat you could prepare yourself, writes director of the Yale Prevention Research Center and HuffPost blogger, David Katz. Not convinced to stay away? Processed meats have also been linked to a <a href="http://www.huffingtonpost.com/2012/01/13/processed-meat-pancreatic-cancer-bacon-sausage_n_1204620.html">higher risk of diabetes <em>and</em> pancreatic cancer</a>.




  • Red Meat


    Yes, the processed picks are <em>worse</em> for your heart, but that doesn't mean you should go wild for steak. Instead, consider it more of a treat than a staple in your diet: It's still high in saturated fat, even when it's unprocessed. "I don't want to suggest that we have to go [completely] plant-based," says Thaik, "but moderation is always the key." If you're not planning on changing your carnivore ways anytime soon, at the very least pick a <a href="http://www.mayoclinic.com/health/cuts-of-beef/MY01387">lean cut of beef</a>, which, according to the USDA, contains less than 10 grams of total fat and 4.5 grams of saturated fat. Or opt for extra-lean, with 5 grams of total fat and less than 2 of saturated fat. Of the 29 cuts that meet these regulations, <a href="http://www.mayoclinic.com/health/cuts-of-beef/MY01387">five are extra-lean</a>, according to the Mayo Clinic, including eye of round roast or steak, sirloin tip side steak, top round roast and steak, bottom round roast and steak and top sirloin steak.




  • Pizza


    That cheesy slice may contain as much as <a href="http://www.realage.com/mens-health-guide/worst-junk-food-for-heart-disease-2">two thirds of your daily recommended limit of saturated fat</a>, according to Real Age, which is found mostly in animal products like beef, pork, butter, cream and milk. The American Heart Association recommends getting no more than <a href="http://www.heart.org/HEARTORG/Conditions/Cholesterol/PreventionTreatmentofHighCholesterol/Know-Your-Fats_UCM_305628_Article.jsp">7 percent of total daily calories from saturated fat</a>. (Based on a 2,000-calories-a-day diet, that totals out to about 15 grams a day of saturated fat). And even though you may think it's "just cheese," many dairy products are actually highly processed, says Thaik. To lighten up, skip extra cheese and top with veggies instead of pepperoni or sausage.




  • Alfredo Sauce


    When you consider that the ingredients in this heavy sauce are <a href="http://allrecipes.com/recipe/alfredo-sauce-2/">butter, cream and cheese</a>, it's easy to see why serving up this pasta dish would pose saturated fat problems -- especially if you're dining out where sauce is ladled over <em>piles</em> of noodles. If you really love an alfredo dish every now and again, ask for the sauce on the side and stick to just a tablespoon or two. If you're making your own at home, try a lightened-up recipe, like <a href="http://recipes.sparkpeople.com/recipe-detail.asp?recipe=163122">this one from SparkPeople</a>, which replaces butter with olive oil, cream with skim milk and cuts down on the amount of cheese.




  • Trans Fats


    These fatty acids are created through processes that make vegetable oils more solid, according to the American Heart Association. They're cheap to produce, are used to make packaged and prepared foods last longer and can be re-used in frying. But <a href="http://www.heart.org/HEARTORG/GettingHealthy/FatsAndOils/Fats101/Trans-Fats_UCM_301120_Article.jsp">trans fats raise LDL or "bad" cholesterol while also lowering HDL or "good" cholesterol</a>, thereby putting your heart at risk. While a number of manufacturers have cut back on trans fat use in light of these health risks, packaged snacks, baked goods and some margarines may still contain it, according to EatingWell. Look for hydrogenated or partially hydrogenated oils on ingredients lists and beware the <a href="http://www.eatingwell.com/nutrition_health/heart_healthy_diet_center/the_worst_and_best_things_to_eat_for_your_heart?page=2">"zero trans fat" labels -- many are hiding .5 grams and rounding down to zero</a>. But considering that the AHA recommends getting <a href="http://www.heart.org/HEARTORG/GettingHealthy/FatsAndOils/Fats101/Trans-Fats_UCM_301120_Article.jsp">no more than 2 grams a day</a>, that adds up, and fast!




  • Fried Foods


    As restaurants use their frying oil over and over again, the <a href="http://www.livescience.com/14781-unhealthy-fried-foods-heart-attacks.html">fat becomes more and more saturated</a>, according to Live Science. And, as mentioned previously, trans fats are often lurking. Even though some restaurants may have cut back in the face of mounting health concerns, a number of joints still fry with solid oils like shortening, says Thaik. However, a 2012 found that <em>how</em> you fry makes a big difference. Among 41,000 Spanish adults, researchers found no link between fried food consumption and heart problems, likely because <a href="http://healthland.time.com/2012/01/25/a-healthier-way-to-eat-fried-foods/">cooking with heart-healthy olive oil is more common</a> than in the U.S, Time.com reported.




  • Soda


    "When we think of heart disease, a lot of people think cholesterol and fat, but we know that sugar, as it relates to obesity and the effect it has on insulin, has a lot to do with the development of artherosclerosis," says Thaik. In fact, drinking one sugary beverage a day leads to a <a href="http://vitals.nbcnews.com/_news/2012/03/12/10656108-soda-drinking-men-at-higher-risk-for-heart-attack">20 percent increase in a man's risk of having a heart attack</a>, according to a 2012 study, <a href="http://thechart.blogs.cnn.com/2012/03/12/a-soda-per-day-may-raise-heart-attack-risk/">even if those empty calories <em>aren't</em> causing weight gain</a>, CNN reported. Soda has previously been linked to <a href="http://www.ncbi.nlm.nih.gov/pubmed/19211821">increased rates of heart disease in women</a>, as well. And diet soda isn't any better. A 2012 study found that a daily diet soda <a href="http://www.nytimes.com/2012/02/28/health/research/diet-soft-drinks-linked-to-risk-of-heart-disease.html">increased risk for stroke, heart attack and death</a>, although the exact cause is not yet fully understood.




  • Fast Food


    There's little on the drive-thru menu that isn't loaded with saturated fat, trans fat, sugar or sodium, making most of your orders recipes for disaster. And the consequences for the heart are nearly immediate. A 2012 study examined the <a href="http://www.huffingtonpost.com/2012/11/27/fast-food-health-arteries-beauty_n_2198725.html">effects of fast food on the arteries after just one meal</a> and found that the ability of the blood vessels to dilate dropped by 24 percent, YouBeauty reported. "Not just fast food but processed food in general has a very high sodium content just by the pure nature of having to do the preservation," says Thaik. Soups and soy sauce are obvious culprits, she says, but saltwater sushi and even bread can be more surprising sources of salt.