title: Anatomy of the obesity paradox in heart failure.
abstract: A counterintuitive phenomenon of survival advantage in obese patients with heart failure (HF) is called obesity paradox. In this review, we emphasize that in nearly all research papers on this subject, there were marked differences between the groups with different body mass index (BMI). Surprisingly, these differences are very consistent and mostly in favor of patients with higher BMI. Obese individuals in HF studies almost invariably were characterized by much younger age, better nutritional status, higher blood pressure, less arrhythmia, less anemia, less valvular regurgitation, better left ventricular systolic function, better lungs, and better renal function. There is no paradox in their better survival. None of the studies confirming the obesity paradox were designed as prospective studies with the purpose to find the effects of BMI on survival. All the studies represent post hoc analysis of clinical trials designed for different purposes, or retrospective studies, or analysis of registries. Multiple baseline differences of subgroups with different BMI likely contribute to the obesity paradox, because not all variables influencing the outcomes can be accounted for.
authors.affiliation: Department of Cardiology, University of South Florida, Tampa, FL, USA, mguglin@gmail.com.
authors.forename: Maya
authors.initials: M
authors.lastname: Guglin
authors.forename: Khyati
authors.initials: K
authors.lastname: Baxi
authors.forename: Mathew
authors.initials: M
authors.lastname: Schabath
mesh_terms: D015992:Body Mass Index; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D009765:Obesity / Q000401:mortality / Q000503:physiopathology*; D011379:Prognosis
references.citation: Am Heart J. 2008 Jul;156(1):13-22
references.pmid: 18585492
references.citation: J Am Coll Cardiol. 2005 Jan 4;45(1):156-8
references.pmid: 15629390
references.citation: Circulation. 2008 Jul 29;118(5):482-90
references.pmid: 18625893
references.citation: Circulation. 2005 Sep 20;112(12):1756-62
references.pmid: 16157772
references.citation: Arch Intern Med. 2005 Aug 8-22;165(15):1797; author reply 1797-8
references.pmid: 16087835
references.citation: Am J Cardiol. 1997 Sep 15;80(6):736-40
references.pmid: 9315579
references.citation: Arch Intern Med. 2005 Aug 8-22;165(15):1796-7; author reply 1797-8
references.pmid: 16087834
references.citation: Eur J Heart Fail. 2011 Feb;13(2):200-6
references.pmid: 20930001
references.citation: J Card Fail. 2003 Feb;9(1):29-35
references.pmid: 12612870
references.citation: Nutrition. 2012 Jun;28(6):616-22
references.pmid: 22261572
references.citation: Am J Med. 2012 Aug;125(8):796-803
references.pmid: 22483510
references.citation: Eur J Heart Fail. 2007 Apr;9(4):397-402
references.pmid: 17166768
references.citation: J Card Fail. 2012 Jan;18(1):62-7
references.pmid: 22196843
references.citation: Eur Heart J. 2006 Jan;27(1):96-106
references.pmid: 16183687
references.citation: J Am Coll Cardiol. 2001 Sep;38(3):789-95
references.pmid: 11527635
references.citation: Am Heart J. 2005 Dec;150(6):1233-9
references.pmid: 16338264
references.citation: Eur J Heart Fail. 2010 Jun;12(6):566-73
references.pmid: 20354030
references.citation: Physiol Rev. 2008 Apr;88(2):389-419
references.pmid: 18391168
references.citation: Arch Intern Med. 2002 Sep 9;162(16):1867-72
references.pmid: 12196085
references.citation: Am Heart J. 2011 Jan;161(1):158-64
references.pmid: 21167349
references.citation: Am J Cardiol. 2006 Oct 1;98(7):944-8
references.pmid: 16996880
references.citation: J Chronic Dis. 1982;35(3):211-9
references.pmid: 7061678
references.citation: J Am Coll Cardiol. 2004 Apr 21;43(8):1439-44
references.pmid: 15093881
references.citation: Int J Cardiol. 2013 Jul 1;166(3):601-5
references.pmid: 22204855
references.citation: Heart. 2000 May;83(5):505-10
references.pmid: 10768897
references.citation: Obesity (Silver Spring). 2010 Oct;18(10):2017-22
references.pmid: 20134413
references.citation: Circulation. 1998 Oct 6;98(14):1472-6
references.pmid: 9760304
references.citation: J Am Coll Cardiol. 1988 Oct;12(4):996-1004
references.pmid: 3417996
references.citation: Am J Cardiol. 2001 Sep 1;88(5):467-72
references.pmid: 11524051
references.citation: Am J Cardiol. 2008 Feb 1;101(3):348-52
references.pmid: 18237598
references.citation: N Engl J Med. 1999 Oct 7;341(15):1097-105
references.pmid: 10511607
references.citation: Am J Med. 2007 Oct;120(10):863-70
references.pmid: 17904457
references.citation: Eur Heart J. 2010 Jan;31(2):222-6
references.pmid: 19687163
references.citation: Heart. 2011 Nov;97(21):1782-7
references.pmid: 21865203
references.citation: J Card Fail. 2011 May;17(5):374-80
references.pmid: 21549293
references.citation: Am Heart J. 2010 Jan;159(1):75-80
references.pmid: 20102870
references.citation: Am J Cardiol. 2009 Oct 15;104(8):1116-21
references.pmid: 19801034
references.citation: Eur J Heart Fail. 2009 Dec;11(12):1189-94
references.pmid: 19887494
references.citation: Circulation. 2003 Nov 4;108(18):2206-11
references.pmid: 14557360
references.citation: Am Heart J. 2007 Jan;153(1):74-81
references.pmid: 17174642
references.citation: J Card Fail. 2002 Aug;8(4):206-15
references.pmid: 12397568
references.citation: Am J Cardiol. 2012 Jul 1;110(1):77-82
references.pmid: 22497678
references.citation: Circulation. 1983 May;67(5):968-77
references.pmid: 6219830
references.citation: Circulation. 1981 Sep;64(3):477-82
references.pmid: 7261280
references.citation: Eur Heart J. 2005 Jan;26(1):58-64
references.pmid: 15615800
references.citation: Ann Thorac Surg. 2005 Jan;79(1):66-73
references.pmid: 15620917
references.citation: N Engl J Med. 2002 Aug 1;347(5):305-13
references.pmid: 12151467
references.citation: Am J Cardiol. 1999 Oct 15;84(8):955-6, A8
references.pmid: 10532524
references.citation: Circulation. 1997 Nov 4;96(9):3248-50
references.pmid: 9386201
references.citation: J Gerontol. 1976 Mar;31(2):155-63
references.pmid: 1249404
references.citation: Am J Cardiol. 2003 Apr 1;91(7):891-4
references.pmid: 12667583
references.citation: Cardiol Rev. 2008 May-Jun;16(3):124-8
references.pmid: 18414183
references.citation: Circulation. 2007 Aug 7;116(6):627-36
references.pmid: 17638930
references.citation: Int J Cardiol. 2013 Aug 20;167(4):1154-8
references.pmid: 22475846
references.citation: Arch Intern Med. 2005 Jan 10;165(1):55-61
references.pmid: 15642875
references.citation: Am J Cardiol. 2010 Mar 1;105(5):581-6
references.pmid: 20185000
references.citation: J Gerontol A Biol Sci Med Sci. 2013 Jun;68(6):705-11
references.pmid: 23051978