Obesity and cardiovascular complications limiting driving
In Spain, obesity affects 1 out of 7 adults and half of the population have overweight.
Obesity accounts for 78% of the cases of hypertension (HT) in men and of 65% in women. It is demonstrated that, for each kg of weight gain, the risk of developing HT increases by 5%.
The waist perimeter is a cardiovascular risk factor. Over 88 cm. in women and over 102 cm. in men are symptoms of alarm, though it is not general obesity as such.
Therefore, abdominal obesity characterized by the existence of visceral fat is associated with a very high risk of ischemic heart disease, and with its main risk factors such as HT and NIDDM.
An individual with a weight of 20% or higher than his ideal weight is defined as obese. Serious or morbid obesity is that exceeding by 100% the ideal weight, directly reducing life expectancy.
An individual between 15 and 39 years with a weight over 115 kg. has an age-adjusted mortality over 200% from expected, so that only 1 of every 7 obese people reach the life expectancy corresponding to their age.
They are caused by fat deposits in the myocardium and pericardium, that in advanced cases can lead to heart failure and sudden death.
Also, the deficient ventilatory mechanics caused by obesity results in an enlarged right ventricle, that in its progression causes right heart failure.
The symptoms of dyspnea, cough, tiredness, foot edema, and cyanosis, among others, hinder significantly driving by reducing markedly concentration and attention.
The specialist will assess the time of the evolution of the disease when driving is not recommended, and specify it in a report.
We should also consider that an obese patient with heart failure whose symptoms do not interfere with driving can suddenly suffer severe arrhythmia with reduction or loss of consciousness, and sudden death.
The severity of dyspnea is associated with the reduction of ventricular function, that in turn is the cause of serious arrhythmia. The assessment of dyspnea is usually a reliable risk indicator.
HT and atherosclerosis are also frequent, with a high incidence of coronary disease such as heart attack or angina.
Varicose veins and deep venous insufficiency often appear, with edema of the ankles and feet, and risk of thrombophlebitis and pulmonary embolism. If the leg heaviness and edema are marked, this will make movement difficult and the patient may not drive.
Advice on Obesity and cardiovascular complications
- Obese patients with serious or uncompensated heart failure or with few symptoms with risks of syncope and sudden death cannot drive.
- Obese drivers with dyspnea and symptoms of low output have a lower attention level and a higher risk of suffering an accident, so they should be advised against driving.
- If the obese driver is repeatedly feeling bad, he should be recommended to stop as soon as possible and ask for help. In no case he will go to the hospital driving.
- If the specialist recommends medication in case of onset of cardiac symptoms, he should be reminded to take it in the car, together with the cardiology report, at sight, or near the driver, in case he needs emergency assistance.
- On long journeys, they are recommended to travel accompanied, to respect the schedule of the medications, if they eat in road to take salt-low and salt-free food, to avoid rush hours and heat, to stop frequently and to walk to elude the worsening of leg edema.
- Obese drivers should be prompted to lose weight, distribute meals along the day, without excesses, drink water, perform exercise and try to avoid troubles and stress, as a prevention of the coronary disease.
- Obese drivers suffering an AMI cannot drive until the specialist, after a time window over six months, can give a prognostic opinion on the condition, with the advice, drugs, and daily activity that the patient can fulfill, including driving.
- If the patient has completed the safety period of the follow-up of his coronary disease and has lost weight, he can drive, warning him that if he notices any sign that can mean a relapse, he should stop driving and ask his physician.
- The patients who have suffered an AMI often suffer mood disorders due to fear. This anguish, together with the depressive susceptibility of obese patients, can interfere with driving and reduce safety.
- In these cases, it would be advisable to recommend that driving is performed accompanied if possible, until they recover the safety to drive.
- Obese drivers with hypotension, pulsatile headache and brain obtundation should be treated early; while this patient keeps the symptoms and blood pressure levels are high, he may not drive.
- As a result, driving will not be recommended in symptomatic and/or treatment-refractory hypertensive obese patient, since these situations make driving difficult and increase the risks when driving.
- The obese patient who is aware of his hypertension and who while driving starts with symptoms, must park his car as soon as possible in area where there is no risk of accident, get calm and wait until the symptoms subside.
- If he does not improve, he will ask for help to be taken to the nearest medical center and that the physician measures blood pressure, confirms the diagnosis and establishes the adequate treatment. With symptoms, he cannot arrive driving at the medical center.
- In order to avoid worsening venous insufficiency, he should be reminded that heating is not directed to his feet, to stop frequently on long journeys to move his legs and place them up, and that he tries to drive in the morning because, at that time of the day, legs are not overloaded for the day passed.
- Obese drivers with varicose veins complicated by bleeding, phlebitis, pain by blow, etc. should rest and they will be recommended not to drive until the limb is free from symptoms and without limitation for driving.
- Drivers with varicose veins should be careful inside the car not to blow with the car commands or pedals. The awkward movements of obese individuals in the small space of the car enhance this risk of which they should be warned.
- Varicose ulcers interfering for their location, symptoms, or immobilization with the set of pedals do not permit driving.
- Obese drivers with infected ulcers, located in sites of support or with the recommendation to rest with the feet up, cannot drive until cure or until expressly indicated by their physician.
- The adverse reactions of cardiac, antiarrhythmic, and hypotensive medication should be notified, as they can interfere with a safe driving.
- Achieving that obese patients lose weight, they will live longer and better, because it will involve simultaneously the prevention of the cardiovascular disease and prevention of traffic accidents.