Reverse Epidemiology of Traditional Cardiovascular Risk Factors in the Geriatric Population

Abstract

Traditional risk factors of cardiovascular death in the general population, including body mass index (BMI), serum cholesterol, and blood pressure (BP), are also found to relate to outcomes in the geriatric population, but in an opposite direction. Some degrees of elevated BMI, serum cholesterols, and BP are reportedly associated with lower – instead of higher – risk of death among the elderly. This phenomenon is termed “reverse epidemiology” or “risk factor paradox” (such as obesity paradox) and is also observed in a variety of chronic disease states such as end-stage renal disease requiring dialysis, chronic heart failure, rheumatoid arthritis, and AIDS. Several possible causes are hypothesized to explain this risk factor reversal: competing short-term and long-term killers, improved hemodynamic stability in the obese, adipokine protection against tumor necrosis factor-α, lipoprotein protection against endotoxins, and lipophilic toxin sequestration by the adipose tissue. It is possible that the current thresholds for intervention and goals levels for such traditional risk factors as BMI, serum cholesterol, and BP derived based on younger populations do not apply to the elderly, and that new levels for such risk factors should be developed for the elderly population. Reverse epidemiology of conventional cardiovascular risk factors may have a bearing on the management of the geriatric population, thus it deserves further attention.

Association of serum vitamin B12 and folate with mortality in incident hemodialysis patients

“…This hypothesis is also supported by prior observations of an association between serum B12 and two indicators of inflammation: C-reactive protein and ferritin. Also, Salles et al [18] showed a similar B12-mortality relationship in elderly adults, another population predisposed to PEW [22]. However, in our study, concurrent adjustment for B12 when folate was the exposure and vice versa did not significantly change the observed associations.…”

Inverse Association Between Serum Non–High‐Density Lipoprotein Cholesterol Levels and Mortality in Patients Undergoing Incident Hemodialysis

“…Given that the atherogenic impact of ApoB and triglyceride-rich lipoproteins typically takes effect over an extended period of time, the possibility that serum non-HDL-C levels in the short-term are more reflective of other factors, such as energy metabolism and nutrition, cannot be discounted. 41 Hence, improved outcomes can be observed in the short-term, whereas during long-term follow-up, elevated non-HDL-C levels may be associated with worse cardiovascular and all-cause mortality. 22 However, given the significant increase in the short-term risk of death in patients with ESRD and the fact that long-term survival by definition is dependent on short-term survival, the value of these observations cannot be overlooked.…”

Brain Natriuretic Peptide and Body Fluid Composition in Patients with Chronic Kidney Disease: A Cross-Sectional Study to Evaluate the Relationship between Volume Overload and Malnutrition

“…The reverse epidemiology of cardiovascular risk factors was studied in patients with CKD [16,17] and heart failure [18] and in the geriatric population [19]. Previous studies using bioimpedance analysis showed that overhydration is prevalent in leaner patients undergoing dialysis therapy [3,20].…”