BMI May Predict Heart Risk in Diabetic Patients

Body mass index may be a simple, noninvasive means of predicting the risk of heart disease in patients with type 2 diabetes, according to research presented at the 2013 American Heart Association Scientific Sessions in Dallas. Investigators at Intermountain Medical Center Heart Institute teamed up with researchers from Johns Hopkins University and the National Institutes of Health to measure coronary artery plaque buildup in study participants and found that BMI was a major controllable predictor of heart disease in asymptomatic diabetes patients. They identified a linear correlation between BMI and plaque volume—the risk of heart disease appeared to increase incrementally with the patient’s BMI. “These findings emphasize, in a new way, the importance of weight control in diabetic patients,” says J. Brent Muhlestein, MD, lead researcher and co-director of cardiovascular research at the Intermountain Medical Center Heart Institute in Murray, Utah. “This study demonstrates that being overweight is bad in and of itself—independent of other risk factors that usually go with increased weight, such as hypertension, worse glucose control, and dyslipidemia,” he explains. “It is associated with increased plaque buildup in the coronary arteries and may increase the risk of heart attack.” Therefore, primary care providers should certainly encourage lifestyle choices that can help patients with diabetes maintain a healthy weight. In addition, these findings may also influence the diabetic management strategy doctors choose for their patients. “Some diabetic medications are more likely to cause weight gain and so choosing medicines that may be less likely to result in weight gain may be considered,” Muhlestein says. “Additionally, in my opinion, for morbidly obese diabetic patients, the findings of this study add another reason to consider gastric bypass surgery.” The researchers emphasize the importance of these findings, given that heart disease causes death in 3 out of 4 patients who have diabetes. For those who don’t exhibit obvious risk factors, heart attack, stroke, or even death, may be the first indicator of heart disease. This research is part of a larger study called Factor-64, a landmark, randomized trial designed to determine if using CT scans to screen for heart disease in diabetic patients who don’t have heart disease symptoms can reduce the risk of future cardiovascular events. “The primary endpoint of the Factor-64 study, which has not yet been reached, is to determine whether asymptomatic screening with CT coronary angiography can result in better long-term outcomes among diabetic patients,” he says. “If that endpoint is positive, then certainly BMI might be one of the factors used to determine which patients should receive screening.” —Colleen Mullarkey Reference Kwan AC, May H, Cater G, Sibley CT, Rosen B, Lima JAC, et al. Coronary plaque volume by cardiac computed tomographic angiography is associated with obesity in diabetic patients: the Factor-64 study. Presented at: 2013 American Heart Association Scientific Sessions. 2013 Nov 16-20; Dallas.