scholarly journals Obesity Paradox" – another look at the problem of cardiovascular disease

2013 ◽  
Vol 10 (4) ◽  
pp. 3-9
Author(s):  
O V Shpagina ◽  
I Z Bondarenko
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Obesity Paradox ◽  
Developed Countries ◽  
Epidemiologic Studies ◽  
Normal Weight ◽  
Overweight And Obesity ◽  
Published Data ◽  
Risk Of Death ◽  
Cardiovascular Prognosis

Major epidemiologic studies over the last century demonstrated that obesity leads to several severe diseases such as diabetes mellitus, hypertension, coronary heart disease, chronic heart failure, cerebrovascular accidents. In developed countries cardiovascular diseases became the main cause of death. In the last 5–6 years some studies showed that people with overweight and obesity of the first degree have a higher life expectancy than people with normal weight. In 2009, the published data showed that the presence of obesity in patients with chronic heart failure does not impair cardiovascular prognosis. Overweight correlates with a decrease in overall mortality by 25%. And in a first degree of obesity the risk of death is reduced by 12%. This phenomenon is called "obesity paradox" and the causes of which are discussed in this review.

scholarly journals Obesity as a risk factor for heart failure: overview of systematic reviews

2022 ◽  
Vol 11 (1) ◽  
pp. e0811124380
Author(s):  
Cleyton Oliveira Bezerra ◽  
Rafael Marinho de Lima Paiva ◽  
Thamires Lucena da Silva ◽  
Vinicius Soares Ribeiro ◽  
Cinthia Caldas Rios ◽  
...  
Keyword(s):  
Heart Failure ◽  
Risk Factor ◽  
Systematic Reviews ◽  
Data Extraction ◽  
Meta Analysis ◽  
Obesity Paradox ◽  
Overweight And Obesity ◽  
Risk Of Death ◽  
Increased Risk ◽  
Overview Of Systematic Reviews

The overweight and population with obesity has an increased risk of mortality from HF. However, some studies point to the existence of an "obesity paradox" where there could be a protective effect on the relative risk of death by HF in these populations with high BMI. In this way, the present study aimed to investigate obesity as a risk factor for heart failure. For this, an overview of systematic reviews was performed by selecting articles from the following databases: "Pubmed", "Scopus" and "SciElo”. A total of 615 articles were found from this initial search, leaving 59 articles for full-text reading, of which 22 articles were included for data extraction using the predefined inclusion criteria. From these 22 studies 73% were meta-analysis and 64% of the studies are of high methodological quality according to AMSTAR-2. Overweight and obesity have demonstrated a close relationship with the onset and increase of mortality by HF, studies have even been found that point to a gene interference in this relationship. In studies reporting on the obesity paradox, the results pointed to a momentary protection from mortality risk.

scholarly journals The Obesity Paradox and Heart Failure: A Systematic Review of a Decade of Evidence

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Emmanuel Aja Oga ◽  
Olabimpe Ruth Eseyin
Keyword(s):  
Heart Failure ◽  
Weight Status ◽  
Obesity Paradox ◽  
Normal Weight ◽  
Conclusive Evidence ◽  
Study Endpoint ◽  
Nyha Classification ◽  
Improved Outcomes ◽  
Observational Cohort

There is scientific consensus that obesity increases the risk of cardiovascular diseases, including heart failure. However, among persons who already have heart failure, outcomes seem to be better in obese persons as compared with lean persons: this has been termed theobesity paradox, the mechanisms of which remain unclear. This study systematically reviewed the evidence of the relationship between heart failure mortality (and survival) and weight status. Search of the PubMed/MEDLINE and EMBASE databases was done according to the PRISMA protocol. The initial search identified 9879 potentially relevant papers, out of which ten studies met the inclusion criteria. One study was a randomized clinical trial and 9 were observational cohort studies: 6 prospective and 3 retrospective studies. All studies used the BMI, WC, or TSF as measure of body fatness and NYHA Classification of Heart Failure and had single outcomes, death, as study endpoint. All studies included in review were longitudinal studies. All ten studies reported improved outcomes for obese heart failure patients as compared with their normal weight counterparts; worse prognosis was demonstrated for extreme obesity (BMI>40 kg/m2). The findings of this review will be of significance in informing the practice of asking obese persons with heart failure to lose weight. However, any such recommendation on weight loss must be consequent upon more conclusive evidence on the mechanisms of the obesity paradox in heart failure and exclusion of collider bias.

scholarly journals Polymorphism of the ITGAM gene (rs7193943) and bioelectric impedance analysis as potential predictors of cachexia in chronic heart failure

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Grzegorz Sobieszek ◽  
Radosław Mlak ◽  
Tomasz Powrózek ◽  
Marcin Mazurek ◽  
Aneta Skwarek-Dziekanowska ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Systolic Pressure ◽  
Impedance Analysis ◽  
Severe Malnutrition ◽  
Pulmonary Artery Systolic Pressure ◽  
Integrin Subunit ◽  
Bioelectric Impedance Analysis ◽  
Cardiac Cachexia ◽  
Risk Of Death

AbstractCardiac cachexia (CC) is an unfavorable metabolic syndrome leading to exacerbation of chronic heart failure (CHF) and a higher risk of death. The main factor contributing to the development of cachexia is the ongoing inflammatory process mediated by genes (e.g. Integrin Subunit Alpha M—ITGAM). The study aimed to assess the relationship between a single nucleotide polymorphism (SNP) -323G > A of the ITGAM and the occurrence of nutritional disorders in patients with CHF. 157 CHF patients underwent clinical and nutritional screening. Body composition was evaluated by bioelectrical impedance analysis (BIA). Patients with cachexia were characterized by significantly lower weight, body mass index (BMI), lower fat mass (FM), albumin, and hemoglobin. Lower values of BIA parameters: capacitance of membrane (Cm), phase angle (PA), and impedance ratio (Z200/Z5) were noted in women. Those patients demonstrated significantly higher values of creatinine, c-reactive protein (CRP), N-terminal prohormone of brain natriuretic peptide (NT-proBNP), and pulmonary artery systolic pressure (PASP). A significantly higher risk of cachexia was reported in patients: aged ≥ 74 years (OR 3.55), with renal failure (OR 3.75), New York Heart Association classification (NYHA) III-IV (OR 2.83), with moderate or severe malnutrition according to the score of subjective global assessment (SGA) (OR 19.01) and AA genotype of ITGAM gene (OR 2.03). Determination of the -323G > A SNP in the ITGAM may prove to be a useful marker (after confirmation in further studies and appropriate validation) in the assessment of the risk of nutritional disorders in patients with CHF.

Abstract P174: Factors Related to Decreased Readmission within 30 Days for Hispanic Heart Failure Patients

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Hong Seok Lee ◽  
Gerald Pekler ◽  
Fernand Visco ◽  
Savi Mushiyev
Keyword(s):  
Heart Failure ◽  
Readmission Rate ◽  
Central Obesity ◽  
Randomized Study ◽  
Obesity Paradox ◽  
Normal Weight ◽  
Obese Group ◽  
Heart Failure Patients ◽  
Number Of Patients ◽  
Heart Failure Exacerbation

Objective: This study was aimed to relate the obesity paradox to readmission and obesity. The obesity paradox remains controversial in the literature. Obesity has detrimental effects on heart failure, but has been found to be paradoxically associated with improved survival. We hypothesized that readmission in heart failure patients is associated with obesity. Method: We analyzed 732 patients who were admitted for heart failure exacerbation and enrolled in our heart failure program and excluded those who did not follow-up or patients discharged from the cardiology clinic. Patients who were readmitted within 30 days for heart failure exacerbation were investigated. 688 patients who have been followed since 2013 were included. BMI (body mass index) and WC (waist circumference) were classified according to NCEP-ATP III. Results: The number of normal weight (BMI <25kg/m 2 ), overweight (30 kg/m 2 >BMI≥25kg/m 2 ) and obesity (BMI≥30kg/m 2 ) were 35.7%, 35.1% and 29.1%, respectively. Central obesity (WC ≥94 cm for men ,and ≥80 for women) were 62%. The number of patients in our selected populations of HFrEF, HFpEF and HFpEF(i) were 456(67.9%),136(20.2%) and 68(11.9%) respectively. A higher readmission rate had a significantly associated with non-obese (BMI less than 30 kg/m 2) group compared to obese group(BMI more than 30 kg/m 2) in HFpEF patients. There was no significant association between central obesity and readmission. In addition, the absence of diabetes mellitus, an ICD (implantable cardioverter defibrillator), no prior cardiac catheterization and age over 65 were associated with a lower readmission rate. Conclusion: The obesity paradox with BMI applied to our study group. The obese group had a significant association with reduced readmission rate compared to the normal or overweight BMI group in HFpEF. WC was not associated with readmission. Higher BMI may be related to better cardiopulmonary fitness in HFpEF. To apply to clinical practice, a large randomized study should be warranted. Targeted management in different types of heart failure could be associated readmission.

Abstract P302: Lack of Obesity Paradox in 30 Day and Annual Cumulative Acute Decompensated Heart Failure Readmissions

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Ravinder Valadri ◽  
Namrata Singhania ◽  
Deborah Deborah ◽  
Richard English ◽  
LeYu Naing ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Obesity Paradox ◽  
Normal Weight ◽  
Study Cohort ◽  
Data Sets ◽  
Index Hospitalization ◽  
Unplanned Hospitalizations ◽  
End Stage

Background: Recent study demonstrated paradoxical relationship between body mass Index (BMI) and all cause mortality in patients with acute decompensated heart Failure (ADHF), where higher BMI was associated with decreased mortality. We sought to test whether this relationship exists between BMI and ADHF readmissions Methods: Consecutive patients presented to the emergency department from March 2014 to July 2015 with the diagnosis of ADHF were analyzed in a retrospective cohort study. Cohort was grouped in to prespecified BMI categories; normal weight (BMI <26 Kg/m2 ), Over weight (BMI 25-30 Kg/m2 ) and Obese (BMI >30 Kg/m2 and above). Primary endpoints were incidence of 30 day ADHF readmission and time to first ADHF readmission from the index hospitalization. Patients with end stage COPD on home O2, cirrhosis and end stage renal failure on dialysis were excluded. Unplanned hospitalizations due to other cause than ADHF were excluded. ADHF hospitalizations were adjudicated by an independent blinded clinician Results: Cohort (N=188) consisted 51(27.1%) normal weight, 61 (32.4%) over weight and 76 (40.4%) obese patients. Females were 63% (N=119), patients with heart failure with preserved ejection fraction were 47% (N=90), Obese [BMI 31(28-38) Kg/m2; Median (IQR)] patients were younger (median age; 77 years vs 83 years; P=0.002), whereas other covariates were similar between groups. In median follow up of 1.2 years, total 30 day ADHF readmissions were 32 and total ADHF admissions were 214. Incidence of both 30 day and total ADHF readmissions were similar in all 3 BMI categories; ANOVA P=0.18 (30 day ADHF readmissions) and P= 0.62 (total ADHF readmissions). Obesity was neither associated with risk for 30 day readmission; OR=0.64 (CI: 0.20 - 2.0; P= 0.45) nor with the time to first ADHF readmission from the index hospitalization; log rank P=0.5 (Figure 1) Conclusions: Higher BMI is not protective against ADHF readmissions in patients with ADHF. Further studies are needed in larger data sets to validate our findings.

Chronic heart failure

2020 ◽  
pp. 217-240
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Mortality Rate ◽  
Adult Population ◽  
Age Groups ◽  
Severe Heart Failure ◽  
Signs And Symptoms ◽  
Developed Countries ◽  
Clinical Syndrome ◽  
The Uk

Heart failure is a complex clinical syndrome of signs and symptoms that suggest the ability of the heart to pump effectively has been impaired. It is distinguished by dyspnoea, effort intolerance, fluid retention, and poor survival. The prevalence of heart failure is around 1–2% in the adult population in developed countries, and 920 000 people in the UK have heart failure. The incidence of heart failure has decreased; however, the number of people newly diagnosed with heart failure has increased. This is thought to be largely due to an ageing population, improvement in the management and survival of people with ischaemic heart disease, and effective treatment of heart failure. The condition can occur in all age groups; however, the incidence and prevalence steeply increase with age. The average age at first diagnosis is typically 77yrs. Chronic heart failure (CHF) has a poor prognosis, the mortality rate for CHF being worse than for many cancers. It is estimated that 70% of those hospitalized for the first time with severe heart failure will die within 5yrs. However, this has been improving, with 6mth mortality rate ↓ from 26% in 1995, 15% in 2009, to 8.9% in 2016. This chapter will outline the aetiology, pathophysiology, and management of CHF, including considerations for palliative care.

scholarly journals Malondialdehyde and Uric Acid as Predictors of Adverse Outcome in Patients with Chronic Heart Failure

2019 ◽  
Vol 2019 ◽  
pp. 1-15 ◽  
Author(s):  
Ewa Romuk ◽  
Celina Wojciechowska ◽  
Wojciech Jacheć ◽  
Aleksandra Zemła-Woszek ◽  
Alina Momot ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Heart Failure ◽  
Uric Acid ◽  
Chronic Heart Failure ◽  
Predictive Biomarkers ◽  
Cox Regression Analysis ◽  
Risk Of Death ◽  
Increased Risk ◽  
Baseline Levels

In chronic heart failure (HF), some parameters of oxidative stress are correlated with disease severity. The aim of this study was to evaluate the importance of oxidative stress biomarkers in prognostic risk stratification (death and combined endpoint: heart transplantation or death). In 774 patients, aged 48-59 years, with chronic HF with reduced ejection fraction (median: 24.0 (20-29)%), parameters such as total antioxidant capacity, total oxidant status, oxidative stress index, and concentration of uric acid (UA), bilirubin, protein sulfhydryl groups (PSH), and malondialdehyde (MDA) were measured. The parameters were assessed as predictive biomarkers of mortality and combined endpoint in a 1-year follow-up. The multivariate Cox regression analysis was adjusted for other important clinical and laboratory prognostic markers. Among all the oxidative stress markers examined in multivariate analysis, only MDA and UA were found to be independent predictors of death and combined endpoint. Higher serum MDA concentration increased the risk of death by 103.0% (HR=2.103; 95% CI (1.330-3.325)) and of combined endpoint occurrence by 100% (HR=2.000; 95% CI (1.366-2.928)) per μmol/L. Baseline levels of MDA in the 4th quartile were associated with an increased risk of death with a relative risk (RR) of 3.64 (95% CI (1.917 to 6.926), p<0.001) and RR of 2.71 (95% CI (1.551 to 4.739), p<0.001) for the occurrence of combined endpoint as compared to levels of MDA in the 1st quartile. Higher serum UA concentration increased the risk of death by 2.1% (HR=1.021; 95% CI (1.005-1.038), p<0.001) and increased combined endpoint occurrence by 1.4% (HR=1.014; 95% CI (1.005-1.028), p<0.001), for every 10 μmol/L. Baseline levels of UA in the 4th quartile were associated with an increased risk for death with a RR of 3.21 (95% CI (1.734 to 5.931)) and RR of 2.73 (95% CI (1.560 to 4.766)) for the occurrence of combined endpoint as compared to the levels of UA in the 1st quartile. In patients with chronic HF, increased MDA and UA concentrations were independently related to poor prognosis in a 1-year follow-up.

scholarly journals The Obesity Paradox in Type 2 Diabetes and Mortality

2016 ◽  
Vol 12 (3) ◽  
pp. 244-251 ◽  
Author(s):  
Deirdre K. Tobias ◽  
JoAnn E. Manson
Keyword(s):  
Type 2 Diabetes ◽  
Body Weight ◽  
Mortality Risk ◽  
Obesity Paradox ◽  
Normal Weight ◽  
Overweight And Obesity ◽  
Epidemiological Methods ◽  
Excess Body Weight ◽  
Methodological Considerations

The obesity paradox for survival among individuals with type 2 diabetes has been observed in some but not all studies. Conflicting evidence for the role of overweight and obesity in all-cause mortality may largely be a result of differences in study populations, epidemiological methods, and statistical analysis. For example, analyses among populations with long-term prevalent diabetes and the accrual of other chronic health conditions are more likely to observe that the sickest participants have lower body weights, and therefore, relative to normal weight, overweight and even obesity appear advantageous. Other mortality risk factors, such as smoking, also confound the relationship between body weight and survival, but this behavior varies widely in intensity and duration, making it difficult to assess and effectively adjust for in statistical models. Disentangling the potential sources of bias is imperative in understanding the relevance of excess body weight to mortality in diabetes. In this review, we summarize methodological considerations underlying the observed obesity paradox. Based on the available evidence, we conclude that the obesity paradox is likely an artifact of biases, and once these are accounted for, it is evident that compared with normal body weight, excess body weight is associated with a greater mortality risk.

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