The study by Curtis et al1(p55) reported interesting data from the Digitalis Investigation Group trial indicating that,
The underlying mechanisms of this paradox remain obscure.
Associations between aortic calcification (a surrogate marker of the atherosclerotic burden) and the risk of morbidity and mortality due to cardiac failure have been recently demonstrated by the Framingham study group.2 Our previous studies pointed out that generally obese women (BMI >30) enjoy cardiovascular benefits of their excessive peripheral fat mass owing to the excessive secretion of adiponectin from subcutaneous adipocytes, which provides insulin-sensitizing, anti-inflammatory, and antiatherogenic effects.3,4 Thus, high BMI, together with the gynoid-type body fat distribution characterized by predominant presence of lower body fat mass, might contribute to deceleration of the progression of coronary artery disease and thereby adverse outcomes of HF.
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