title: The obesity paradox in men with coronary heart disease and heart failure: the role of muscle mass and leptin.
abstract: OBJECTIVE
  We have investigated the role of muscle mass, natriuretic peptides and adipokines in explaining the obesity paradox.
  
  
  BACKGROUND
  The obesity paradox relates to the association between obesity and increased survival in patients with coronary heart disease (CHD) or heart failure (HF).
  
  
  METHODS
  Prospective study of 4046 men aged 60-79 years followed up for a mean period of 11 years, during which 1340 deaths occurred. The men were divided according to the presence of doctor diagnosed CHD and HF: (i) no CHD or HF ii), with CHD (no HF) and (iii) with HF.
  
  
  RESULTS
  Overweight (BMI 25-9.9 kg/m(2)) and obesity (BMI ≥ 30 kg/m(2)) were associated with lower mortality risk compared to men with normal weight (BMI 18.5-24.9 kg/m(2)) in those with CHD [hazards ratio (HR) 0.71 (0.56,0.91) and 0.77 (0.57,1.04); p=0.04 for trend] and in those with HF [HR 0.57 (0.28,1.16) and 0.41 (0.16,1.09; p=0.04 for trend). Adjustment for muscle mass and NT-proBNP attenuated the inverse association in those with CHD (no HF) [HR 0.78 (0.61,1.01) and 0.96 (0.68,1.36) p=0.60 for trend) but made minor differences to those with HF [p=0.05]. Leptin related positively to mortality in men without HF but inversely to mortality in those with HF; adjustment for leptin abolished the BMI mortality association in men with HF [HR 0.82 (0.31,2.20) and 0.99 (0.27,3.71); p=0.98 for trend].
  
  
  CONCLUSIONS
  The lower mortality risk associated with excess weight in men with CHD without HF may be due to higher muscle mass. In men with HF, leptin (possibly reflecting cachexia) explain the inverse association.
authors: Department of Primary Care and Population Health, UCL, London, UK. Electronic address: g.wannamethee@ucl.ac.uk.
authors: S Goya
authors: SG
authors: Wannamethee
authors: Department of Primary Care and Population Health, UCL, London, UK.
authors: A Gerald
authors: AG
authors: Shaper
authors: Department of Population Health Sciences and Education, St George's, University of London, London, UK.
authors: Peter H
authors: PH
authors: Whincup
authors: Department of Primary Care and Population Health, UCL, London, UK.
authors: Lucy
authors: L
authors: Lennon
authors: Department of Primary Care and Population Health, UCL, London, UK.
authors: Olia
authors: O
authors: Papacosta
authors: Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
authors: Naveed
authors: N
authors: Sattar
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology; D003327:Coronary Disease / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D006801:Humans; D020738:Leptin / Q000097:blood*; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology*; D018482:Muscle, Skeletal / Q000502:physiology; D009765:Obesity / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends
chemical_list: D015415:Biomarkers; D020738:Leptin
keywords: BMI; Body mass index; C-reactive protein; CHD; CRP; Cardiovascular disease; Coronary heart disease; HF; Heart failure; Leptin; MAMC; MI; Mid arm muscle circumference; Mortality; Myocardial infarction; N-terminal pro-brain natriuretic peptide; NT-proBNP; Obesity; WC; Waist circumference