Medicine Cabinet: Obesity and heart attacks

I take so many medications and still had a heart attack. How much of a role do obesity, physical fitness and nutrition play in causing a heart attack?

Obesity, physical fitness and nutrition each play a large role in causing a heart attack (myocardial infarction).

OBESITY Heart attacks are more likely to occur in obese people. This is partly due to the way obesity contributes to high blood pressure and makes diabetes and cholesterol problems more likely. Obesity also increases heart attack risk by causing a thickening (hypertrophy) of the heart muscle and by increasing the chance that you will have sleep apnea. People with sleep apnea are more likely to develop heart disease.

Several studies have estimated the risk for obese people compared with people of normal weight. One example is the Nurses' Health Study. It found that nonsmoking women who had a body mass index (BMI) at or above 32 had a quadrupled risk for dying of a heart attack compared to thin women with a BMI below 19.

PHYSICAL FITNESS Exercise improves blood pressure, cholesterol and weight. Even in modest amounts, exercise protects against heart attacks. Experts blame poor exercise for about 12 percent of the risk for heart attack around the world. Physical fitness, as determined by the degree of peak exercise you can perform, has a direct relationship to heart attack risk. The measurement of fitness commonly used is metabolic equivalents (METs). According to a study, every increase of one MET in exercise capacity is linked to a 12 percent improvement in longevity.

NUTRITION A diet low in salt and high in fruits and vegetables can reduce your risk of a heart attack.

The amount of salt in the diet may play a bigger-than-expected role in heart attack and stroke risk than previously thought. Most Americans eat about two teaspoons of salt a day. If all American adults older than 35 cut their salt intake in half, a computer simulation predicts that during the next decade, we would see 54,000 to 99,000 fewer heart attacks each year, and 32,000 to 66,000 fewer strokes a year.