About two months ago, I wrote a little screed which got me quoted in a newspaper that “I’m fat, I know I’m fat, and I don’t care that you don’t like it”. The point was that people in talk radio (and some politicians) are feeding the notion that fat people are what are causing health care costs to go up. The most blatant example of this was Michael Savage advocating that “fat people” be denied health care insurance by government edict (Mr Conservative?).
This attitude also is widely held in the medical community despite the fact that the science and data says otherwise. Having just been hospitalized for fainting and immediately being put on high blood pressure medication and cholesterol lowering medications while I was literally strapped in a bed and unable to have a rational discussion, I feel ever more strongly now about this subject.
The “gold standard” for estimating risk of heart disease and stroke is the Framingham Risk Score. I’m 53, not diabetic, have never smoked, not African American, no family history of premature death due to heart attacks, my total cholesterol is under 200, my systolic blood pressure is below 140 without taking any medications. My 10 year risk of having a heart attack is about 5% (that’s 1/2 of 1% per year – most of which is probably when I’m 60+). That makes my risk of having a stroke or a heart attack significantly less than the average person my age – but people see a 300 pound man and their instinct says “high heart attack risk” when in fact that’s not based in fact. Add to this that I was on a heart monitor for 4 days and didn’t have so much as a flutter and the sonogram showed my heart being normal in the way it beats and its size (no early signs of congestive heart failure) and no heart murmer or other indication of heart disease or valve damage.
So now I’m still on a blood pressure medication to lower my systolic pressure from the 140 range to the 120 range, despite the fact that if you look at the Framingham scale that 145 untreated and 120 treated have identical risk profiles for heart attack and stroke. So maybe you’re thinking, well it can’t hurt anything to take it…. One of the side effects of lisinipril/hctx is that it can cause symptoms of low blood pressure – fainting and dizziness – which is the reason I wound up in the hospital in the first place – in addition to causing weight GAIN.
You’ll notice that weight and BMI (body mass index) are not factors – there is a reason for that – BMI is not an indicator of heart attack/stroke risk – in fact the highest risk is in the people who have very low BMIs. To have a low BMI, you have to have very little muscle tissue which means you are highly inactive and a good chance you’re a smoker. People who are moderately obese have a lower risk than those of normal weight. The real measurement of risk is comparing the size of your waist to the size of your hips, which nobody has measured yet.
So looking to the future when the Health Care Czar is empowered to make rules based on politics, not science – if I make the above case to my doctor and he insists that I continue to take this medication despite all of the scientific data that says he’s wrong and I become “non compliant” with my doctor’s “orders”, what will the government do next?
