Treatment of obesity: need to focus on high risk abdominally obese patients
BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7288.716 (Published 24 March 2001) Cite this as: BMJ 2001;322:716
All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
Dear Editor:
Which are the best clinical parameters for early identification of
the high cardiovascular risk patients? Desprès et.al. recognize the
superiority of waist circumference (WC) over body mass index (BMI), at
least for men.1 Little and Byrne reinforce this idea, but both groups also
recognize the limitations of both WC and BMI, and the importance of other
accepted risk factors (RF).2 Previously, Liu and Manson commented on the
work of Ashton et.al.(January issue of the European Heart Journal), that
shows the close correlation of BMI and both specific or global risk in
women.3 They also recognize the limitations of BMI.
For a more complete,early, practical and economical assessment of
cardiovascular risk, we propose the use of PulsexMass Index (PMI),
together with WC and other commonly used RF.4-5
PulsexMass Index=Resting Heart Rate(RHR)xBody Mass Index divided by
1730 (or 72x24). Based on our investigations, a PMI of 0.7-1.0 would be
ideal. A PMI over 1.3 suggests a high global risk.
PMI reflects not only the metabolic consecuences of overweight, but
also the oxidative metabolic rate, stress or sympathetic stimulation,
hyperinsulinemia, inflammatory activity, physical fitness and side effects
of drugs like tachycardia, potent vasodilation and water retention. The
therapeutic interventions or lifestyle modifications, should improve the
treated cardiovascular RF without increasing, or better reducing PMI in
order to reduce risk and possibly also mortality (like betablockers).
We found a very close correlation (r=0.95) between PMI and the global
cardiovascular risk according to Framingham.4-5
In several studies about physical fitness, overweight and mortality, and
also heart rate recovery after exercise, when RHR and BMI permited a
calculation of PMI, we could easily identify the high risk groups.5
Thus, PMI, a widely accesible index of physical signs, permits a more
complete assessment of cardiovascular risk. It should be done routinely in
every patient.
Prof. Dr. med. Enrique Sànchez-Delgado
Member of the Executive Committee of the International Society of Internal
Medicine (ISIM) and of the Asociaciòn Nicaraguense de Medicina Interna
(ANMI).
References:
1. Desprès J-P, Lemieux I, Prud`homme D.Treatment of obesity: need to
focus on high risk abdominally obese patients. BMJ 2001; 322:716-720.
2. Little P, Byrne CD. Abdominal obesity and the
"hypertriglyceridaemic waist" phenotype. BMJ 2001; 322:687-689.
3. Liu S, Manson JAE. What is the optimal weight for cardiovascular
health?. BMJ 2001;322:631-632.
4. Ross G, Stier J, Lloyd-Jones DM, Levy D, Sànchez-Delgado E, et.al.
Lifetime risk of developing coronary heart disease. Lancet 1999: 353:924-
925.
5. Sànchez-Delgado E, Liechti H. Importance of Heart Rate and
PulsexMass Index for the assessment of Cardiovascular Risk. Presented at
the 25th World Congress of Internal Medicine, Cancùn, Mèxico, June 4-9,
2000.
Competing interests: No competing interests
Body mass index
Sir - If we divide a person's length by his age, we do not get his
velocity. Likewise, the body mass index, obtained by dividing a
person's body weight (in kg) by the square of his length (in m), is not a
measure of pressure. Lately, scientific journals [1,2] seem
to favour expressing this index in kg/m2, which, according to the Système
International, should then be converted to pascal (1 Pa
= 1 kg/m2).
The body mass index is just what its name implies, an index, and not a
real physical quantity like, e.g., body mass per area foot
sole. Therefore, the index should remain dimensionless.
Hans van Maanen
Science editor
Het Parool, Postbus 433, 1000 AK Amsterdam, The Netherlands
e-mail: hvm@parool.nl
[Footnotes]
Competing interests: No competing interests