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‘Obesity Paradox’ Makes Heart Disease Outlook Puzzling

Last Updated: May 19, 2009.

Although obesity is associated with poor cardiovascular health, an "obesity paradox" shows that obese individuals with certain cardiovascular diseases or risk factors may have a better prognosis than people with a healthy weight, according to a review published in the May 26 issue of the Journal of the American College of Cardiology.

TUESDAY, May 19 (HealthDay News) -- Although obesity is associated with poor cardiovascular health, an "obesity paradox" shows that obese individuals with certain cardiovascular diseases or risk factors may have a better prognosis than people with a healthy weight, according to a review published in the May 26 issue of the Journal of the American College of Cardiology.

Carl J. Lavie, M.D., of the Ochsner Medical Center in New Orleans, and colleagues write that obesity increases total blood volume and cardiac output, as well as being associated with greater cardiac workload. Obesity is often associated with left ventricular hypertrophy and chamber dilation, and obese individuals are more likely to have hypertension.

However, research has shown higher mortality in elderly hypertensive patients in the leanest body mass index quintile. A recent meta-analysis found that overweight and obese patients with heart failure had less cardiovascular and all-cause mortality than those with a normal weight, the authors note. In addition, a systematic review found lower mortality in overweight and obese patients with coronary heart disease than their leaner counterparts.

"Although an obesity paradox exists, in that overweight and obese patients with established cardiovascular diseases seem to have a more favorable prognosis than leaner patients, the constellation of data still support purposeful weight reduction in the prevention and treatment of cardiovascular diseases. Further research is needed in all of these areas, and if the current obesity epidemic continues, we may soon witness an unfortunate end to the steady increase in life expectancy," the authors conclude.

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