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Prog Cardiovasc Dis. 2018 Jul - Aug;61(2):142-150. doi: 10.1016/j.pcad.2018.07.003. Epub 2018 Jul 5.

An Overview and Update on Obesity and the Obesity Paradox in Cardiovascular Diseases.

Author information

1
Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA, United States of America.
2
Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA, United States of America. Electronic address: clavie@ochsner.org.
3
Pauley Heart Center, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, United States of America.
4
Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America.
5
Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain.

Abstract

Obesity increases a number of cardiovascular disease (CVD) risk factors, but patients with many types of CVD may have a better prognosis if classified as overweight or obese, a phenomenon known as the "obesity paradox". This paradoxical benefit of a medically unfavorable phenotype is particularly strong in the overweight and class I obesity, and less pronounced in the more severe or morbidly obese populations (class II-III and greater). Rather than an obesity paradox, it is possible that this phenomenon may represent a "lean paradox", in which individuals classified as normal weight or underweight may have a poorer prognosis with respect to CVD, as a result of a progressive catabolic state and lean mass loss. Cardiorespiratory fitness (CRF) is a fundamental part of this discussion. A greater CRF is associated with lower CVD risk, regardless of body mass index (BMI). Also, the assessment of body composition compartments (i.e., fat mass, fat-free mass, lean mass) and the presence of metabolic derangements may be better indicators of CVD risk than BMI alone. The focus of this review is to summarize the current evidence of the obesity paradox. Moreover, we discuss the utility and limitations of BMI for cardiometabolic risk stratification, in addition to concepts such as "metabolically healthy obesity" (MHO) and the "fat but fit" phenomenon, which describe patients who are diagnosed with obesity using BMI, but without major metabolic derangements and with greater CRF, respectively. Finally, we propose that obese patients presenting with an excess body fat, yet without metabolic abnormalities, should still be viewed as an "at risk" population, and as such should receive advice to change their lifestyle to improve their CRF and to prevent the development of impaired fasting glucose, diabetes mellitus and other CVD risk factors as a form of primary prevention.

KEYWORDS:

Atrial fibrillation; Cardiorespiratory fitness; Cardiovascular; Cardiovascular disease; Coronary heart disease; Heart failure; Obesity; Obesity paradox; Physical activity

PMID:
29981771
DOI:
10.1016/j.pcad.2018.07.003
[Indexed for MEDLINE]

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