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J Am Med Dir Assoc. 2015 Nov 1;16(11):933-9. doi: 10.1016/j.jamda.2015.07.014. Epub 2015 Sep 9.

Reverse Epidemiology of Traditional Cardiovascular Risk Factors in the Geriatric Population.

Author information

1
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.
2
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.
3
Division of Nephrology and Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine Medical Center, Orange, CA.
4
Department of Medicine, Providence Medical Institute, West Hills, CA.
5
Nephrology Section, Department of Medicine, Veterans Affairs Long Beach Healthcare System, Long Beach, CA.
6
Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN.
7
Department of Medicine, University of California Irvine Medical Center, Orange, CA.
8
Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN; Memphis Veterans Affairs Medical Center, Memphis, TN.
9
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.

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.

KEYWORDS:

Reverse epidemiology; cardiovascular risk factors; mortality; obesity paradox; risk factor paradox

PMID:
26363864
PMCID:
PMC4636955
DOI:
10.1016/j.jamda.2015.07.014
[Indexed for MEDLINE]
Free PMC Article

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