The Obesity Paradox, Cardiorespiratory Fitness, and Coronary Heart Disease

McAuley, Paul; Artero, Enrique G.; Sui, Xuemei; Lee, Duck-chul; Church, Timothy S.; Lavie, Carl J.; Myers, J.; Espana-Romero, Vanessa; Blair, Steven N.

doi:10.1016/j.mayocp.2012.01.013

Cited by 227 publications

(144 citation statements)

References 29 publications

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“…Hazard ratios (boxes) and 95% confidence intervals (error bars represent values) after adjusting for age, baseline examination year, physical activity, smoking hyperlipidemia, diabetes and family history of cardiovascular disease. Reproduced with permission from McAuley et al (65) …”

Section: Resultsmentioning

confidence: 99%

The relationship between obesity and coronary artery disease

Jahangir¹,

Schutter²,

Lavie³

2014

Translational Research

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Obesity continues to be a growing issue in the United States with an estimated prevalence of 72 million people. There are major health implications associated with obesity including its relationship with hypertension, diabetes mellitus type 2, the metabolic syndrome, and dyslipidemia, all independent risk factors for CAD. Despite the increased risk of developing CAD, in recent years an "obesity paradox" has been described in which moderately obese individuals with established cardiovascular disease, including CAD, appear to have mortality similar to their normal weight counterparts. This review discusses the relationship between obesity and CAD, including the increased risk of hypertension, diabetes mellitus, the metabolic syndrome, and dyslipidemia along with a discussion of the obesity paradox and the benefits of weight reduction.

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Section: Resultsmentioning

confidence: 99%

The relationship between obesity and coronary artery disease

Jahangir¹,

Schutter²,

Lavie³

2014

Translational Research

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“…In the obesity paradox, data in both patients with CHD and HF indicate that cardiorespiratory fitness markedly alters the relationship between adiposity and subsequent prognosis. 9 In a study of ≈10 000 patients with CHD followed for close to 15 years, McAuley et al 133 using ACLS data demonstrated that those with moderate to high levels of cardiorespiratory fitness, defined as not being in the bottom tertile of cardiorespiratory fitness for age and sex, have a good prognosis, regardless of BMI, WC, or BF%, whereas in those with low cardiorespiratory fitness, an obesity paradox was present during long-term follow up, meaning that those with low cardiorespiratory fitness and the lowest categories of body composition (BMI, WC, and BF%) have a worse CVD-and all-cause mortality than did heavier CHD patients. 134 Likewise, Lavie et al 135 demonstrated the same impact of cardiorespiratory fitness to alter the obesity paradox in 2066 patients with systolic HF during 3-year follow-up and those with poor cardiorespiratory fitness, defined as peak Vo 2 < 14 mL/kg per minute, a strong obesity paradox was present, meaning that those with BMI≥30 kg/m 2 had the best survival, followed by overweight HF patients, and the worst survival occurred in those with normal BMI (18.5-25 kg/m 2 ; underweight patients, who almost have the worst survival, were excluded).…”

Section: Obesity Paradox In Patients With Cvdmentioning

confidence: 99%

Obesity and Cardiovascular Disease

Ortega

Lavie

Blair

2016

Circulation Research

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T here is overall agreement in the scientific and clinical community that obesity is one of the major public health problems of this century. The first documented reports on obesity date from the end of the 19th century and the beginning of the 20th century.1-3 From these days to date, >57 000 articles have been published in PubMed including the term obesity in the title, with these figures being 3× larger when searching by obesity also in the abstract. Figure 1 graphically Abstract: The prevalence of obesity has increased worldwide over the past few decades. In 2013, the prevalence of obesity exceeded the 50% of the adult population in some countries from Oceania, North Africa, and Middle East. Lower but still alarmingly high prevalence was observed in North America (≈30%) and in Western Europe (≈20%). These figures are of serious concern because of the strong link between obesity and disease. In the present review, we summarize the current evidence on the relationship of obesity with cardiovascular disease (CVD), discussing how both the degree and the duration of obesity affect CVD. Although in the general population, obesity and, especially, severe obesity are consistently and strongly related with higher risk of CVD incidence and mortality, the one-sizefits-all approach should not be used with obesity. There are relevant factors largely affecting the CVD prognosis of obese individuals. In this context, we thoroughly discuss important concepts such as the fat-but-fit paradigm, the metabolically healthy but obese (MHO) phenotype and the obesity paradox in patients with CVD. About the MHO phenotype and its CVD prognosis, available data have provided mixed findings, what could be partially because of the adjustment or not for key confounders such as cardiorespiratory fitness, and to the lack of consensus on the MHO definition. In the present review, we propose a scientifically based harmonized definition of MHO, which will hopefully contribute to more comparable data in the future and a better understanding on the MHO subgroup and its CVD prognosis. (Circ Res.

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“…32 It is muscle strength not muscle mass that is a marker of muscle quality. 35 Muscle strength is negatively associated with metabolic risks. 36 • Endothelial progenitor cells: Less coronary atherosclerosis demonstrated in autopsies of obese 37 and paradoxical preservation of vascular function in severely obese individuals 38 may provide partial protection from atherogenesis through a greater mobilization of endothelial progenitor cells.…”

Section: Discussionmentioning

confidence: 99%

Impact of Body Mass Index on In-Hospital Outcomes after Percutaneous Coronary Interventions

et al. 2017

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Background: Obesity, measured on the basis of body mass index (BMI), is an independent cardiovascular risk factor. However, some studies have reported the obesity paradox after percutaneous coronary intervention (PCI). The relationship between BMI and clinical outcomes after PCI has not been thoroughly investigated, especially in Bangladesh.Method: This cross sectional observational study was conducted at National Institute of Cardiovascular Diseases, on total 100 patients who underwent PCI with two equally divided groups on the basis of BMI of Asian ethnicity: Group I (BMI < 23 kg/m2) and Group II (BMI e 23.0 kg/m2). In-hospital outcomes were observed and recorded after PCI.Results: The mean BMI of study population was 23.9 ± 1.9 kg/m2. The sum of occurrence of adverse in-hospital outcomes was 14.0%. Complications were significantly (p < 0.01) higher in Group I than Group II. Among all adverse in-hospital outcomes, only acute left ventricular failure was found to be statistically significant between groups (p < 0.01). The difference of mean duration of hospital stay after PCI was higher in Group-I which was statistically significant (p < 0.01). Diabetes mellitus and dyslipidemia were found to be the independent predictors for developing adverse in-hospital outcome (OR= 1.68 and 1.46; 95% CI = 1.25 2.24 and 1.16 1.83; p = 0.018 and 0.040, respectively). BMI was inversely associated with adverse in-hospital outcome after PCI (OR = 0.95; 95% CI = 0.91 0.98; p = 0.007).Conclusion: BMI is inversely associated with adverse in-hospital outcomes after PCI. The underweight and normal weight people are at greater risk to experience in-hospital adverse outcomes than overweight and obese people following PCI.Cardiovasc. j. 2017; 10(1): 31-39

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The Obesity Paradox, Cardiorespiratory Fitness, and Coronary Heart Disease

Abstract: In men with documented or suspected CHD, CRF greatly modifies the relation of adiposity to mortality. Using adiposity to assess mortality risk in patients with CHD may be misleading unless fitness is considered.

Cited by 227 publications

References 29 publications

The relationship between obesity and coronary artery disease

The relationship between obesity and coronary artery disease

Obesity and Cardiovascular Disease

Impact of Body Mass Index on In-Hospital Outcomes after Percutaneous Coronary Interventions

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