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For Elderly Heart Patients, Extra Weight May Be Beneficial

A new study by a group of Columbia researchers led by Mathew S. Maurer, MD, indicates, surprisingly, that elderly patients (75 and over) who had a BMI (body mass index) of 25 and over had a lower risk of complications and death from cardiovascular surgery than did those with a lower BMI.

The study was conducted on 1,450 patients who underwent cardiovascular surgery between 1991 and 1998. Patients were between 75 and 94 years of age, with a mean age of 79. The authors concluded that, for these patients, and especially for those who were very old, "An increased BMI does not increase the risk of complications from cardiovascular surgery."

Niloo M. Edwards, MD, Former Director of Cardiac Transplantation at CUMC, is senior author of the study, entitled "The Effect of Body Mass Index on Complications from Cardiac Surgery in the Oldest Old." The article appeared in the Journal of the American Geriatric Society, vol. 50, June 2002. Dr. Edwards directed the AGE^sm program at Columbia University Medical Center, whose goal is expansion of treatment options for geriatric heart patients. In addition, the AGE program was created to increase the medical community's ability to care for elderly heart disease patients.

The study is significant because, as the article states, "The aging of the population will have profound influences on health care in the United States and in many other developed countries." It included all cardiovascular procedures, including coronary artery bypass grafting, aortic valve repair, and others.

In the general population, overweight patients often experience adverse outcomes following surgery. The results of the study were surprising to the investigator.

"Our results seem to be paradoxical," Dr. Maurer says. "Outcomes were significantly worse for thinner patients, in terms of wound infections and other complications, and also in terms of mortality. Furthermore, the impact seems to be greater for the most senior patients. This is contrary to findings for younger patients, where obesity is detrimental to overall health."

The results of this study point to how much we do not yet know about older patients. The study tells us that physicians and surgeons need to learn more about the physiology of the older patient. Only by exploring what happens to people as they age will we have the information we need to tailor our care to this patient population.