Being Overweight Puts Men at Higher Risk of Heart Attack, Stroke, and Premature Death


The latest research study reported in Circulation: Journal of the American Heart Association debunks the idea of “fat but fit.” It finds that overweight or obese middle-aged men are at a higher risk of heart attack, stroke and premature death — even if they don’t have the metabolic syndrome.

“Previous studies have put forward the existence of a “metabolically healthy” subgroup of obese individuals who are at no increased cardiovascular risk, but if you follow them long enough, you find out there appears to be no such thing as metabolically healthy obesity,” said Johan Ärnlöv, M.D., Ph.D., associate professor of cardiovascular epidemiology at Uppsala University in Uppsala, Sweden.

Previous studies followed people for 13 years or less, while the current study followed men for 30-year. These previous studies found that obese people without the metabolic syndrome (MetS) were not at an increased risk of heart disease or stroke.

Researchers classified men as having the metabolic syndrome if they had three or more of these findings at the time of their original exam: 1) impaired ability to handle glucose, elevated blood pressure, 3) high levels of the blood fats called triglycerides, 4) low levels of “good” HDL cholesterol, or 5) BMI at least 29.4 kg/m2. A large waist, indicating excessive fat tissue around the abdomen, is usually used in assessing the metabolic syndrome but was not available for this group of men.

The current study involved 1,758 men born between 1920 and 1924 in Uppsala. Each underwent a health evaluation at age 50, and those who had diabetes or had been hospitalized for heart disease were not included.

During the follow-up, 681 suffered a cardiovascular event (death or hospitalization from heart attack, stroke or heart failure) – including 386 cardiovascular deaths. After adjusting for age, smoking and the men’s levels of “bad” LDL-cholesterol, the researchers compared men with MetS and/or high body mass index (BMI) with those of normal weight and without MetS.

The researchers found normal weight men with MetS had 63% higher risk of cardiovascular disease (CVD). Overweight men without MetS had a 52% higher risk of CVD and increased to 74% in overweight men with MetS. Obese men without MetS had a 95% higher risk compared to 155% higher risk in obese men with MetS.


“Normal weight men with the metabolic syndrome were at increased risk, and overweight and obese men were at increased risk even if they did not have the metabolic syndrome,” Ärnlöv said.

“Doctors need to address a person’s total risk, including smoking, cholesterol, blood pressure and weight. Some researchers have suggested that a heavy person without other risk factors didn’t need to lose weight, but our data does not support this notion.”

Long-term data on these factors is not available for women, but Ärnlöv said doctors should pay attention to women’s weight as well as their other cardiovascular risk factors.

“I don’t think we should consider obesity without the MetS to be benign in women just because we don’t have the data yet,” Ärnlöv said.

The results were not surprising, according to an American Heart Association spokesperson.

“We’ve known for years that obesity worsens or exacerbates many risk factors,” said Barry Franklin, Ph.D., chair of the American Heart Association’s council on Nutrition, Physical Activity and Metabolism. “What was interesting about this study was that the findings differed from previous studies – which involve much shorter follow up – that suggested that obese people without metabolic syndrome were not at risk. This study really contradicts that and I believe it’s in large part related to longer follow up.”

Franklin said the role of fitness in reducing cardiovascular disease was not discussed in this study. As New Year’s resolutions approach he urged patients to recognize that even a five to pound weight loss can make a significant health benefit.

Co-authors are: Erik Ingelsson, M.D., Ph.D.; Johan Sundström, M.D., Ph.D., and Lars Lind, M.D., Ph.D. Individual author disclosures can be found on the manuscript.