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 e know gluttony is one of the seven deadly sins, but
a new study suggests it may also trigger a potentially deadly
medical complication, such as a heart attack.
 Reporting
at the American Heart Association's 73rd Scientific Sessions,
a US Department of Veterans Affairs (VA) researcher finds that
people at risk for heart disease were four times more likely
than others to suffer a myocardial infarction (MI) soon after
eating a big meal.
"To our
knowledge, this study is the first to show overeating or having
a heavy meal is a risk factor for triggering heart attacks,"
said Francisco Lopez-Jimenez, MD, MSc, a cardiology fellow with
VA's Boston Health Care System in Brockton, Massachusetts. He
is also on staff at Brigham and Women's Hospital and Harvard
Medical School.
Dr. Lopez-Jimenez
and colleagues interviewed nearly 2,000 patients at 45 different
hospitals, including several VA medical centers, shortly after
their heart attacks. The researchers asked about possible and
proven triggers of heart attack, including "unusually heavy
meals."
They found
that 158 patients reported having an unusually heavy meal during
the 26 hours preceding the MI. Twenty-five patients had the meal
in the two hours before the attack, defined by the researchers
as the "hazard" period, while only six patients reported
a large meal the day before, defined by the team as the "control"
period.
By comparing
the two time slots -- 24 hours apart the study controlled for
the possibility that time of day, and not the meal itself, was
the trigger. The remaining patients in the group of 158 had their
heavy meal at various other times in the 26 hours before the
heart attack, but no other time period emerged as significant.
The researchers
believe there are two possible explanations for how a heavy meal
could bring on a heart attack. One, fatty meals may affect the
function of the endothelium, the inner layer of the arteries,
although details about what the patients ate were not recorded
for this study. Secondly, eating increases the blood level of
norepinephrine, a hormone that acutely raises blood pressure
and pulse rate.
Despite the
potential linkage of heavy meals to an MI, Lopez-Jimenez stressed
the difference between risk factors for the development of coronary
disease, such as obesity, hypertension, smoking and lack of exercise
and possible triggers for an MI.
"Overeating
should be considered as a heart attack trigger, much in the same
way as extreme physical activities and severe anger episodes
may cause an MI."
So what's
the take home message for those with excessive or voracious appetites?
The doctor advises exercising in moderation. "People at
risk for a heart attack should be careful not only about the
total caloric intake they eat every day, but the size of individual
meals as well."
Collaborating
with VA's Dr. Lopez-Jimenez on the study were Murray A. Mittleman,
MD; Malcom Maclure, ScD; Geoffrey H. Tofler, MD; Jane B. Sherwood,
RN; and James E. Muller, MD, all of Beth Israel Deaconess Medical
Center in Boston. This study was funded by the National Heart,
Lung and Blood Institute. VA research provides improved medical
care for veterans, as well as the general population. Through
its unique affiliation with medical schools, VA plays a crucial
role in educating future physicians in research and clinically
oriented areas. 
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