0
Editor's Correspondence |

Obesity Paradox as a Component of Reverse Epidemiology in Heart Failure

Kamyar Kalantar-Zadeh, MD, PhD, MPH; Stefan D. Anker, MD, PhD; Andrew J. S. Coats, DM; Tamara B. Horwich, MD; Gregg C. Fonarow, MD
Arch Intern Med. 2005;165(15):1797. doi:10.1001/archinte.165.15.1797-a.
Text Size: A A A
Published online

Extract

We read with great interest the article by Curtis et al1 on the inverse relationship between BMI and survival in patients with HF due to systolic dysfunction. We were pleased to see that the findings of this study further support our respective groups initial descriptions of an inverse association between BMI and mortality in this patient population.24 However, it is important to note that BMI is not the only conventional cardiovascular risk factor with a paradoxical association with clinical outcomes in patients with HF.4 High levels of both low-density lipoprotein and total cholesterol have been associated with a survival advantage in HF5 along with an inverse relationship between blood pressure and outcome in patients with HF.4 These consistent findings across an array of cardiovascular risk factors in patients with HF support the more inclusive term reverse epidemiology.4 Reverse epidemiology has also been observed in hemodialysis patients, elderly individuals, and patients with advanced malignancies, AIDS, and other chronic diseases.6 This means that more than 20 million individuals, including 5 million patients with HF, in the United States alone may be subject to this reverse epidemiology. We believe that this could have very important implications for public advice on health matters because conventional recommendations pertaining to the management of cardiovascular risk factors such as weight reduction or aggressive treatment of hypercholesterolemia may not be appropriate.6

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
/>
First page PDF preview

Figures

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles
Obesity and cardiovascular outcomes: a review. Eur Heart J Acute Cardiovasc Care Published online Feb 13, 2014.;
Jobs
brightcove.createExperiences();