Women, heart disease, and obesity.

Now considered an independent risk factor for heart disease, obesity is linked to a sedentary lifestyle, hypertension, elevated lipids, and diabetes. Overweight/obesity alters cardiac dynamics by increasing the metabolic demand associated with expanded adipose tissue. Obesity also influences diastolic function, neuroendocrine activation, and renal sodium retention. Despite women’s increased awareness of heart disease, overweight/ obesity rates have not declined appreciatively. Analysis of NHANES data (National Health and Nutrition and Examination Survey) showed that in recent years the prevalence of overweight/obesity in women has remained a lingering concern. In 2003 to 2004, among all women 20 to 39 years, 51.7% were overweight and 28.9% were obese; among women 40 to 59 years, 68.1% were overweight and 38.8% were obese; and among women 60 years and older, 68.9% were overweight and 31.5% were obese. Even more alarming is that in non-Hispanic black women and Mexican American women, obesity rates across all age groups are significantly higher than obesity rates for non-Hispanic white women. Overweight/obesity as a factor in developing heart failure may be more important in women. In 2002, the relation between body mass index (weight in kilograms divided by height in meters squared) and the incidence of heart failure was investigated in 5881 participants in the Framingham Heart Study (average age 55 years; 54% women). Heart failure developed in 496 people (258 women; 238 men). When adjusting for established risk factors for heart disease, there was an increase in the risk of heart failure of 5% for men and 7% for women for each increment of 1 in the body mass index. This graded increase in the risk of heart failure was seen across all categories of body mass index. These investigators concluded that addressing obesity in populations of people can lessen the burdens associated with heart failure. Others have described gender differences in heart failure in relation to overweight/obesity. For example, Lund and Mancini discuss gender differences in hormonal influence, response to injury, pressure overload and aging, which may account for differences in epidemiology, response to treatment, and long-term outcomes.