The “obesity paradox” – is it a positive effect on the course of cardio-vascular events? (A literature review)

Authors

  • V. H. Kadzharian Zaporizhzhia State Medical University, Ukraine, Ukraine

DOI:

https://doi.org/10.14739/2310-1210.2021.2.228836

Keywords:

obesity, cardiovascular diseases, evidence-based medicine

Abstract

The aim: to analyze the literature and study the “obesity paradox” phenomenon, pathological conditions and categories of patients with its existence.

Methods. The analytical, bibliosemantic, system approach and system analysis methods were used in the work.

Results. The article presents the basic current views on the effect of obesity on the cardiovascular disease course according to evidence-based medicine. Randomly analyzed results have shown a decrease in mortality after cardiovascular events in overweight individuals.

The “obesity paradox” was revealed in the analysis of 10-year survival after stroke in the Framingham Study patients. In the group of overweight and obese patients, mortality rates after ischemic stroke were lower than in the group with normal body weight ([RR] = 0.70, 95 % CI 0.55–0.90, /M3.005). Researchers suggest that a moderately increased body weight may be associated with previously unknown protective factors.

The “obesity paradox” has shown a more favorable course of myocardial infarction among certain categories of patients (with a history of cardiovascular events) with higher body weight. In individuals with heart failure who underwent resynchronisation therapy, high body mass index values were associated with a reduced risk of developing primary endpoints. Predicting the risk of acute coronary syndrome has shown better results in overweight patients. Obese patients have been diagnosed with less severe calcification of the carotid arteries. Numerous theories that explain this phenomenon include the protective function of adiponectin as well as the protective effect of muscle tissue.

Conclusions. Overweight in people with various pathologies in certain conditions can improve the course of cardiovascular events, which underlies the “obesity paradox”. In the mechanisms of the “obesity paradox”, the protective properties of adiponectin as well as the protective function of muscle tissue are given the highest priority.

 

Author Biography

V. H. Kadzharian, Zaporizhzhia State Medical University, Ukraine

MD, PhD, Associate Professor of the Department of Internal Diseases 1 and Simulation Medicine

References

  1. Nagarajan, V., Kohan, L., Holland, E., Keeley, E. C., & Mazimba, S. (2016). Obesity paradox in heart failure: a heavy matter. ESC Heart Failure, 3(4), 227-234. https://doi.org/10.1002/ehf2.12120
  2. Del Brutto, O. H., Mera, R. M., & Atahualpa Project Investigators. (2017). Inverse relationship between the body mass index and severity of carotid siphon calcifications (another obesity paradox): Results from the Atahualpa Project. Atherosclerosis, 259, 1-4. https://doi.org/10.1016/j.atherosclerosis.2017.02.023
  3. Kee, C. C., Sumarni, M. G., Lim, K. H., Selvarajah, S., Haniff, J., Tee, G., Gurpreet, K., Faudzi, Y. A., & Amal, N. M. (2017). Association of BMI with risk of CVD mortality and all-cause mortality. Public Health Nutrition, 20(7), 1226-1234. https://doi.org/10.1017/S136898001600344X
  4. Hussain, G., Raza Baig, M. A., Ghaffar, A., Zaheer, S., Azam Raheel, H. M., & Khalid, S. (2017). Effect of body mass index on early outcomes of coronary artery bypass grafting. Journal of the Pakistan Medical Association, 67(4), 595-599.
  5. Lee, Y. M., Kim, K. S., Jacobs, D. R., Jr, & Lee, D. H. (2017). Persistent organic pollutants in adipose tissue should be considered in obesity research. Obesity Reviews, 18(2), 129-139. https://doi.org/10.1111/obr.12481
  6. Kachur, S., Morera, R., De Schutter, A., & Lavie, C. J. (2018). Cardiovascular Risk in Patients with Prehypertension and the Metabolic Syndrome. Current Hypertension Reports, 20(2), Article 15. https://doi.org/10.1007/s11906-018-0801-2
  7. Baker, J. F., Newman, A. B., Kanaya, A., Leonard, M. B., Zemel, B., Miljkovic, I., Long, J., Weber, D., & Harris, T. B. (2019). The Adiponectin Paradox in the Elderly: Associations With Body Composition, Physical Functioning, and Mortality. The Journals of Gerontology: Series A, 74(2), 247-253. https://doi.org/10.1093/gerona/gly017
  8. Badrick, E., Sperrin, M., Buchan, I. E., & Renehan, A. G. (2017). Obesity paradox and mortality in adults with and without incident type 2 diabetes: a matched population-level cohort study. BMJ Open Diabetes Research & Care, 5(1), Article e000369. https://doi.org/10.1136/bmjdrc-2016-000369
  9. Alhamshari, Y. S., Alnabelsi, T., Mulki, R., Cepeda-Valery, B., Figueredo, V. M., & Romero-Corral, A. (2017). Right ventricular function measured by TAPSE in obese subjects at the time of acute myocardial infarction and 2year outcomes. International Journal of Cardiology, 232, 181-185. https://doi.org/10.1016/j.ijcard.2017.01.033
  10. Aparicio, H. J., Himali, J. J., Beiser, A. S., Davis-Plourde, K. L., Vasan, R. S., Kase, C. S., Wolf, P. A., & Seshadri, S. (2017). Overweight, Obesity, and Survival After Stroke in the Framingham Heart Study. Journal of the American Heart Association, 6(6), Article e004721. https://doi.org/10.1161/JAHA.116.004721
  11. Ingremeau, D., Grall, S., Valliet, F., Desprets, L., Prunier, F., Furber, A., & Bière, L. (2020). Prognostic impact of body mass index on in-hospital bleeding complications after ST-segment elevation myocardial infarction. World Journal of Cardiology, 12(1), 44-54. https://doi.org/10.4330/wjc.v12.i1.44
  12. Grandin, E. W., Wand, A., Zamani, P., Rame, J. E., & Verdino, R. J. (2016). Relation of Body Mass Index to Long-Term Survival After Cardiac Resynchronization Therapy. The American Journal of Cardiology, 118(12), 1861-1867. https://doi.org/10.1016/j.amjcard.2016.08.079
  13. Heo, S., Kwon, S., Lee, Y. M., Shin, J. Y., & Lee, D. H. (2020). Comparison of Trends in Blood Pressure and the Prevalence of Obesity Among Korean and American Adolescents: A 12-Years Cross-sectional Study. Journal of Preventive Medicine and Public Health, 53(1), 45-55. https://doi.org/10.3961/jpmph.19.198
  14. Kouvari, M., Chrysohoou, C., Dilaveris, P., Georgiopoulos, G., Magkas, N., Aggelopoulos, P., Panagiotakos, D. B., & Tousoulis, D. (2019). Skeletal muscle mass in acute coronary syndrome prognosis: Gender-based analysis from Hellenic Heart Failure cohort. Nutrition, Metabolism & Cardiovascular Diseases, 29(7), 718-727. https://doi.org/10.1016/j.numecd.2019.03.011
  15. Moholdt, T., Lavie, C. J., & Nauman, J. (2018). Sustained Physical Activity, Not Weight Loss, Associated With Improved Survival in Coronary Heart Disease. Journal of the American College of Cardiology, 71(10), 1094-1101. https://doi.org/10.1016/j.jacc.2018.01.011
  16. Holroyd, E. W., Sirker, A., Kwok, C. S., Kontopantelis, E., Ludman, P. F., De Belder, M. A., Butler, R., Cotton, J., Zaman, A., Mamas, M. A., & British Cardiovascular Intervention Society and National Institute of Cardiovascular Outcomes Research. (2017). The Relationship of Body Mass Index to Percutaneous Coronary Intervention Outcomes: Does the Obesity Paradox Exist in Contemporary Percutaneous Coronary Intervention Cohorts? Insights From the British Cardiovascular Intervention Society Registry. JACC: Cardiovascular Interventions, 10(13), 1283-1292. https://doi.org/10.1016/j.jcin.2017.03.013
  17. Zhang, J., Xu, L., Li, J., Sun, L., & Qin, W. (2020). Association between obesity-related anthropometric indices and multimorbidity among older adults in Shandong, China: a cross-sectional study. BMJ Open, 10(5), Article e036664. https://doi.org/10.1136/bmjopen-2019-036664
  18. Read, S. H., Lewis, S. C., Halbesma, N., & Wild, S. H. (2017). Measuring the Association Between Body Mass Index and All-Cause Mortality in the Presence of Missing Data: Analyses From the Scottish National Diabetes Register. American Journal of Epidemiology, 185(8), 641-649. https://doi.org/10.1093/aje/kww162
  19. Abi Khalil, C., Sulaiman, K., Singh, R., Jayyousi, A., Asaad, N., AlHabib, K. F., Alsheikh-Ali, A., Al-Jarallah, M., Bulbanat, B., AlMahmeed, W., Dargham, S., Ridha, M., Bazargani, N., Amin, H., Al-Motarreb, A., AlFaleh, H., Elasfar, A., Panduranga, P., & Al Suwaidi, J. (2017). BMI is inversely correlated to the risk of mortality in patients with type 2 diabetes hospitalized for acute heart failure: Findings from the Gulf aCute heArt failuRE (Gulf-CARE) registry. International Journal of Cardiology, 241, 262-269. https://doi.org/10.1016/j.ijcard.2017.02.119
  20. Mariscalco, G., D'Errigo, P., Biancari, F., Rosato, S., Musumeci, F., Barbanti, M., Ranucci, M., Santoro, G., Badoni, G., Fusco, D., Ventura, M., Tamburino, C., & Seccareccia, F. (2019). Early and late outcomes after transcatheter versus surgical aortic valve replacement in obese patients. Archives of Medical Science, 16(4), 796-801. https://doi.org/10.5114/aoms.2019.85253
  21. Wan, H., Wu, S., Wang, J., Yang, Y., Zhu, J., Shao, X., Huang, B., & Zhang, H. (2017). Body mass index and the risk of all-cause mortality among patients with nonvalvular atrial fibrillation: a multicenter prospective observational study in China. European Journal of Clinical Nutrition, 71(4), 494-499. https://doi.org/10.1038/ejcn.2016.183
  22. Brida, M., Dimopoulos, K., Kempny, A., Liodakis, E., Alonso-Gonzalez, R., Swan, L., Uebing, A., Baumgartner, H., Gatzoulis, M. A., & Diller, G. P. (2017). Body mass index in adult congenital heart disease. Heart, 103(16), 1250-1257. https://doi.org/10.1136/heartjnl-2016-310571

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Published

2021-04-16

How to Cite

1.
Kadzharian VH. The “obesity paradox” – is it a positive effect on the course of cardio-vascular events? (A literature review). Zaporozhye Medical Journal [Internet]. 2021Apr.16 [cited 2026May13];23(2):304-8. Available from: https://zmj.zsmu.edu.ua/article/view/228836

Issue

Vol. 23 No. 2 (2021)

Section

Review

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