title: Reverse Epidemiology of Traditional Cardiovascular Risk Factors in the Geriatric Population.
abstract: Traditional risk factors of cardiovascular death in the general population, including body mass index (BMI), serum cholesterol, and blood pressure (BP), are also found to relate to outcomes in the geriatric population, but in an opposite direction. Some degrees of elevated BMI, serum cholesterols, and BP are reportedly associated with lower, instead of higher, risk of death among the elderly. This phenomenon is termed "reverse epidemiology" or "risk factor paradox" (such as obesity paradox) and is also observed in a variety of chronic disease states such as end-stage renal disease requiring dialysis, chronic heart failure, rheumatoid arthritis, and AIDS. Several possible causes are hypothesized to explain this risk factor reversal: competing short-term and long-term killers, improved hemodynamic stability in the obese, adipokine protection against tumor necrosis factor-α, lipoprotein protection against endotoxins, and lipophilic toxin sequestration by the adipose tissue. It is possible that the current thresholds for intervention and goal levels for such traditional risk factors as BMI, serum cholesterol, and BP derived based on younger populations do not apply to the elderly, and that new levels for such risk factors should be developed for the elderly population. Reverse epidemiology of conventional cardiovascular risk factors may have a bearing on the management of the geriatric population, thus it deserves further attention.
authors.affiliation: Division of Nephrology and Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine Medical Center, Orange, CA; Department of Population Health and Disease Prevention, Program in Public Health, University of California Irvine, Irvine, CA.
authors.forename: Seyed-Foad
authors.initials: SF
authors.lastname: Ahmadi
authors.affiliation: Division of Nephrology and Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine Medical Center, Orange, CA; Nephrology Section, Department of Medicine, Veterans Affairs Long Beach Healthcare System, Long Beach, CA.
authors.forename: Elani
authors.initials: E
authors.lastname: Streja
authors.affiliation: Division of Nephrology and Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine Medical Center, Orange, CA.
authors.forename: Golara
authors.initials: G
authors.lastname: Zahmatkesh
authors.affiliation: Department of Medicine, Providence Medical Institute, West Hills, CA.
authors.forename: Dan
authors.initials: D
authors.lastname: Streja
authors.affiliation: Nephrology Section, Department of Medicine, Veterans Affairs Long Beach Healthcare System, Long Beach, CA.
authors.forename: Moti
authors.initials: M
authors.lastname: Kashyap
authors.affiliation: Division of Nephrology and Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine Medical Center, Orange, CA.
authors.forename: Hamid
authors.initials: H
authors.lastname: Moradi
authors.affiliation: Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN.
authors.forename: Miklos Z
authors.initials: MZ
authors.lastname: Molnar
authors.affiliation: Division of Nephrology and Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine Medical Center, Orange, CA.
authors.forename: Uttam
authors.initials: U
authors.lastname: Reddy
authors.affiliation: Department of Medicine, University of California Irvine Medical Center, Orange, CA.
authors.forename: Alpesh N
authors.initials: AN
authors.lastname: Amin
authors.affiliation: Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN; Memphis Veterans Affairs Medical Center, Memphis, TN.
authors.forename: Csaba P
authors.initials: CP
authors.lastname: Kovesdy
authors.affiliation: Division of Nephrology and Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine Medical Center, Orange, CA; Department of Population Health and Disease Prevention, Program in Public Health, University of California Irvine, Irvine, CA; Nephrology Section, Department of Medicine, Veterans Affairs Long Beach Healthcare System, Long Beach, CA; Department of Epidemiology, UCLA School of Public Health, Los Angeles, CA. Electronic address: kkz@uci.edu.
authors.forename: Kamyar
authors.initials: K
authors.lastname: Kalantar-Zadeh
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
keywords: Reverse epidemiology; cardiovascular risk factors; mortality; obesity paradox; risk factor paradox