The Obesity Paradox

Curtis, Jeptha P.; Selter, Jared G.; Wang, Yongfei; Rathore, Saif S.; Jovin, Ion S.; Jadbabaie, Farid; Kosiborod, Mikhail; Portnay, Edward L.; Sokol, Seth I.; Bader, Feras; Krumholz, Harlan M.

doi:10.1001/archinte.165.1.55

Cited by 689 publications

(134 citation statements)

References 41 publications

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“…Elevated levels of cholesterol have been reported to be a good predictor of survival in other populations including chronic heart failure [20], chronic respiratory failure [21], HIV [22], cancer [22] and rheumatoid arthritis [23]. Liu et al [12] reported a higher death rate from CVD in patients with low cholesterol levels, yet this relationship was not reported when patients had normal levels of inflammation and did not experience malnutrition.…”

Section: Discussionmentioning

confidence: 99%

Reverse Epidemiology of Lipid-Death Associations in a Cohort of End-Stage Renal Disease Patients

Bowden

Bounty²,

Shelmadine³

et al. 2011

Nephron Clin Pract

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Background and Aims: Cardiovascular disease is the leading cause of death among end-stage renal disease (ESRD) patients with hypercholesterolemia as a major cause. A few studies have demonstrated counter-intuitive findings known as reverse epidemiology where normal levels of cholesterol are associated with higher levels of mortality. The purpose of this study was to determine if there are reverse epidemiological associations between lipid risk factors and mortality in ESRD patients. Methods: ESRD (n = 438) patients were recruited from 4 outpatient dialysis units. Patients were tracked for 36 months until study completion or death with mortality status as the outcome measure. Results: Analysis of covariance revealed significant differences at posttest and reverse epidemiological effects for total cholesterol (p = 0.0001), low-density lipoprotein cholesterol (LDL) (p = 0.023), LDL particle number (p = 0.0001), LDL size (p = 0.009), triglycerides (p = 0.0001), and very low-density lipoprotein cholesterol (p = 0.036). A step-wise linear regression revealed weak, but significant predictors of mortality with total cholesterol (β = 0.263, p = 0.017) and LDL (β = –0.177, p = 0.045). A Cox death hazard ratio revealed LDL size as a significant predictor of mortality in this study. Conclusions: Our study discovered reverse epidemiology in a number of lipid variables. Additionally regression revealed that LDL and total cholesterol were predictors of mortality with lower levels being more predictive of death.

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Section: Discussionmentioning

confidence: 99%

Reverse Epidemiology of Lipid-Death Associations in a Cohort of End-Stage Renal Disease Patients

Bowden

Bounty²,

Shelmadine³

et al. 2011

Nephron Clin Pract

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“…Increased BMI is associated with an increased risk of heart failure. However, in contrast to what is observed in the general population, Curtis et al 27 found out that overweight patients with heart failure have a lower risk of death, when compared to patients who have a healthy weight. These findings confirm the existence of an "obesity paradox" among patients with established heart failure 27 .…”

mentioning

confidence: 81%

“…However, in contrast to what is observed in the general population, Curtis et al 27 found out that overweight patients with heart failure have a lower risk of death, when compared to patients who have a healthy weight. These findings confirm the existence of an "obesity paradox" among patients with established heart failure 27 . However, if obesity is protective, then loss of weight attempts could be associated with increased mortality risk 26 .…”

mentioning

confidence: 81%

“…A decreased nitric oxide production is only one manifestation of endothelial dysfunction in the case of pulmonary hypertension. Nitric oxide can act via a number of additional mechanisms, such as programmed cell death, cytotoxic effects or modulation of myocyte oxygen consumption, all of which may result in impaired cardiac function and prognosis in patients with heart failure 27 .…”

Section: Figure 2 -Regression Linear Plots In All Patients Showing Wementioning

confidence: 99%

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A dieta com baixo teor de sódio é de fato indicada para todos os pacientes com insuficiência cardíaca estável?

Nakasato¹,

Strunk²,

Guimarães³

et al. 2010

Arq. Bras. Cardiol.

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“…BMI and total body fat were also independently predictive of event‐free survival 39. The existence of obesity paradox in chronic stable HF has been described extensively in the literature 5, 38, 40, 41…”

Section: Obesity Paradox In Chronic Stable and Acute Decompensated Hementioning

confidence: 93%

Obesity paradox in heart failure: a heavy matter

et al. 2016

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Obesity and heart failure are two of the leading causes of morbidity and mortality in the world. The relationship between obesity and cardiovascular diseases is complex and not fully understood. While the risk of developing heart failure has been shown to be higher in patients who are obese, there is a survival advantage for obese and overweight patients compared with normal weight or low weight patients. This phenomenon was first described by Horwich et al. and was subsequently confirmed in other large trials. The advantage exists irrespective of the type, aetiology, or stage of heart failure. Patients with morbid obesity (body mass index >40 kg/m2), however, do not have the same survival advantage of their obese counterparts. There are several alternative indices of obesity available that may be more accurate than body mass index. The role of weight loss in patients with heart failure is unclear; thus, providing sound clinical advice to patients remains difficult. Future prospective trials designed to evaluate the link between obesity and heart failure will help us understand more fully this complex relationship.

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The Obesity Paradox

Cited by 689 publications

References 41 publications

Reverse Epidemiology of Lipid-Death Associations in a Cohort of End-Stage Renal Disease Patients

Reverse Epidemiology of Lipid-Death Associations in a Cohort of End-Stage Renal Disease Patients

A dieta com baixo teor de sódio é de fato indicada para todos os pacientes com insuficiência cardíaca estável?

Obesity paradox in heart failure: a heavy matter

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