Obesity Paradox" – another look at the problem of cardiovascular disease
https://doi.org/10.14341/omet201343-9
Abstract
Major epidemiologic studies over the last century demonstrated that obesity leads to several severe diseases such as diabetes mellitus, hypertension, coronary heart disease, chronic heart failure, cerebrovascular accidents. In developed countries cardiovascular diseases became the main cause of death. In the last 5–6 years some studies showed that people with overweight and obesity of the first degree have a higher life expectancy than people with normal weight. In 2009, the published data showed that the presence of obesity in patients with chronic heart failure does not impair cardiovascular prognosis. Overweight correlates with a decrease in overall mortality by 25%. And in a first degree of obesity the risk of death is reduced by 12%. This phenomenon is called "obesity paradox" and the causes of which are discussed in this review.
References
1. AACE Medical Guidelines for clinical practice for growth hormone use in growth hormone – deficient adults and transition patients, 2009. Update ENDOCRINE PRACTICE. 2009; 15 September/October 1.
2. Angeras O., Albertsson P., Karason K. Evidence for obesity paradox in patients with acute coronary syndromes: a report from the Swedish Coronary Angiography and Angioplasty Registry. Eur Heart J. 2013 Feb; 34(5): 345–53.
3. Calle E., Thun M., Petrelli J. Body-Mass Index and Mortality in a Prospective Cohort of U.S. Adults N Engl J Med. 1999; 341: 1097–1105.
4. Carmichael J.D., Danoff A., Milani D. GH peak response to GHRH-arginine: relationship to insulin resistance and other cardiovascular risk factors in a population of adults aged 50–90. Clin Endocrinol (Oxf). 2006; 65(2): 169–77.
5. Carrillo A., Rising R., Tverskaya R. Effects of Exogenous Recombinant Human Growth Hormone on an Animal Model of Suboptimal Nutrition. J Am Coll Nutr. June 1998; 17 (3): 276–281.
6. Сlinicaltrials.gov/. http://clinicaltrials.gov/ct2/show/NCT01438086?term=RESUS+AMI&rank=1.
7. Cuneo RC, Salomon F, McGauley GA, Sonksen PH. The growth hormone deficiency syndrome in adults. Clin Endocrinol. 1992; 37: 387–397.
8. Degoulet P, Legrain M, Réach I. Mortality risk factors in patients treated by chronic hemodialysis. Report of the Diaphane collaborative study. 1982; 31(2): 103–10.
9. Dessi-Fulgheri P, Sarzani R, Serenelli M. Low calorie diet enhances renal, hemodynamic, and humoral effects of exogenous atrial natriuretic peptide in obese hypertensives. Hypertension. 1999; 33: 658–62.
10. Dorner TE, Rieder A. Obesity paradox in elderly patients with cardiovascular diseases. 2012 Feb 23; 155(1): 56–65.
11. Dudina A, Cooney MT, Bacquer DD. Relationships between body mass index, cardiovascular mortality, and risk factors: a report from the SCORE investigators. Eur J Cardiovasc Prev Rehabil. 2011; Oct 18(5): 731–42.
12. Feldman AM, Combes A, Wagner D. The role of tumor necrosis factor in the pathophysiology of heart failure. J Am Coll Cardiol. 2000 Mar 1; 35 (3): 537–44.
13. Fleischmann E, Teal N, Dudley J. Influence of excess weight on mortality and hospital stay in 1346 hemodialysis patients. Kidney Int. 1999 Apr; 55(4): 1560–7.
14. Fonarow GC, Srikanthan P, Costanzo MR. An obesity paradox in acute heart failure: analysis of body mass index and in hospital mortality for 108,927 patients in the Acute Decompensated Heart Failure. National Registry. 2007; 153(1): 74–81.
15. Habbu A., Lakkis N., Dokainish H. The Obesity Paradox: Fact or Fiction? Am J Cardiol. 2006; 98 (7): 944–948.
16. Hall JE, Hildebrandt DA, Kuo J. Obesity hypertension: role of leptin and sympathetic nervous system; Am J Hypertens. 2001 Jun; 14 (6 Pt 2): 103S–115S.
17. Hassani SE, Chu WW, Wolfram RM. Clinical outcomes after percutaneous coronary intervention with drug-eluting stents in dialysis patients. 2006.
18. Hastie CE, Padmanabhan S, Slack R. Obesity paradox in a cohort of 4,880 consecutive patients undergoing percutaneous coronary intervention. Eur Heart J. 2010 Jan; 31(2): 222–6.
19. Hong NS, Kim KS, Lee IK. The association between obesity and mortality in the elderly differs by serum concentrations of persistent organic pollutants: a possible explanation for the obesity paradox. Int J Obes (Lond). 2012 Sep; 36(9): 1170–5.
20. Iranmanesh A, Lizarrade G, Veldhuis JD. Age and relative adiposity are specific negative determinants of the frequency and amplitude of growth hormone (GH) secretory bursts and the half-life of endogenous GH in health men. J Clin Endocrinol Metab. 1991; 73(5): 1081–1088.
21. Ittermann T, Noord C, Friedrich N. The association between insulin-like growth factor-I and cardiac repolarization. Growth Hormone & IGF Research. 2012; 22 (1): 1–5.
22. Janssen J, Lamberts S. The role of IGF-I in the development of cardiovascular disease in type 2 diabetes mellitus: is prevention possible? Eur J Endocrinol. 2002; 146 (4): 467–477.
23. Janssen J, Stolk R, Pols H. Serum total IGF-I, free IGF-I, and IGFB-1 levels in an elderly population: relation to cardiovascular risk factors and disease. Arterioscler Thromb Vase Biol. 1998; 18: 277–282.
24. Kalantar-Zadeh K, Block G, Horwich T. Reverse epidemiology of conventional cardiovascular risk factors in patients with chronic heart failure. J Am Coll Cardiol. 2004; 43: 1439–44.
25. Kern Ph., Ranganathan S., Li Ch., Adipose tissue tumor necrosis factor and interleukin-6 expression in human obesity and insulin resistance. Am J Physiol. 2001; 280 E: 745–751.
26. Lavie CJ, De Schutter A, Patel DA. Body composition and survival in stable coronary heart disease: impact of lean mass index and body fat in the "obesity paradox". 2012 Oct 9; 60(15): 1374–80.
27. Lavie CJ, Mehra MR, Milani RV. Obesity and heart failure prognosis: paradox or reverse epidemiology. Eur Heart J. 2005; 26: 5–7.
28. Lavie CJ, Milani RV, Ventura HO. Disparate effects of left ventricular geometry and obesity on mortality in patients with preserved left ventricular ejection fraction. Am J Cardiol. 2007; 100: 1460–4.
29. Lin SX, Pi-Sunyer EX. Prevalence of the metabolic syndrome among US middle-aged and older adults with and without diabetes – a preliminary analysis of the NHANES 1999–2002 data. Ethn Dis. 2007; 17(1): 35–9.
30. Longenecker CT, Dunn W, Jiang Y. Adipokines and vascular health in treated HIV infection: an obesity paradox? AIDS. 2013 Mar 4. [Epub ahead of print].
31. Lundberg G.D. Is there a relationship between waist circumference and mortality? 2008; 10(8): 202. Epub 2008 Aug 28.
32. Maeda N., Takahashi M., Funahashi T. PPAR-ligands increase expression and plasma concentration of adiponectin, an adipose-derived protein. Diabetes. 2001; 50: 2094–2099.
33. Makimura H, Stanley T, Mun D. Reduced Growth Hormone Secretion Is Associated with Increased Carotid Intima-Media Thickness in Obesity. J Clin Endocrinol Metab. 2009 December; 94(12): 5131–5138.
34. McNeill AM, Rosamond WD, Girman CJ. The metabolic syndrome and 11-year risk of incident cardiovascular disease in the atherosclerosis risk in communities (ARIC) study. Diabetes care. 2005; 28(2): 385–90 Feb.
35. Niebauer J, Volk HD, Kemp M. Endotoxin and immune activation in chronic heart failure: a prospective cohort study. Lancet. 1999 May 29; 353(9167): 1838–42.
36. Oreopoulos A, McAlister FA, Kalantar-Zadeh K. The relationship between body mass index, treatment, and mortality in patients with established coronary artery disease: a report from APPROACH. Eur Heart J. 2009; 30: 2584–92.
37. Oreopoulos A, Padwal R, Kalantar-Zadeh K. Body mass index and mortality in heart failure: a meta-analysis. Am Heart J. 2008; 156(1): 13–22.
38. Pocock S.J., McMurray J.J., Dobson J. Weight loss and mortality risk in patients with chronic heart failure in the candesartan in heart failure: assessment of reduction in mortality and morbidity (CHARM) programme. Eur Heart J. 2008 Nov; 29(21): 2641–50.
39. Rajamanickam A., Kapadia S., Butler S. Does “The Obesity Paradox” exist for survival after a Percutaneous intervention? J Am Coll Cardiol. 2010; 55, Issue 10s1.
40. Rajpathak S, Gunter M, Wylie-Rosett J. The role of insulin-like growth factor-I and its binding proteins in glucose homeostasis and type 2 diabetes. Diabetes Metab Res Rev. 2009; 25 (1): 3–12.
41. Rasmussen M., Hvidberg A., Juul, A. “Massive weight loss restores 24-hour growth hormone release profiles and serum insulin-like growth factor-I levels in obese subjects,” The Journal of Clinical Endocrinology & Metabolism. 1995; 80 (4): 1407–1415.
42. Ren J, Samson WK, Sowers JR. Insulin-like growth factor I as a cardiac hormone: physiological and pathophysiological implications in heart disease. J Mol Cell Cardiol. 1999; 31: 2049–2061.
43. Romero-Corral A, Montori VM, Somers VK. Association of Body weight with total mortality and with cardiovascular events in Coronary artery disease: a systematic review of cohort studies. Lancet 2006; 368: 666–78.
44. Sattar, N., G. Wannamethee, N. Sarwar, J. Adiponectin and coronary heart disease: a prospective study and meta-analysis. Circulation. 2006; 114(7): 623–9.
45. Schneider HJ, Klotsche J, Saller B. Associations of age-dependent IGF-I SDS with cardiovascular diseases and risk conditions: cross-sectional study in 6773 primary care patients. European Journal of Endocrinology. 2008; 158: 153–161.
46. Shibata R., Izumiya Y., Sato K. “Adiponectin protects against the development of systolic dysfunction following myocardial infarction”, Journal of Molecular and Cellular Cardiology. 2007; 42 (6): 1065–1074.
47. Shibata R., Ouchi N., Ito M. Adiponectin-mediated modulation of hypertrophic signals in the heart. Nature Medicine. 2004; 10 (12): 1384–1389.
48. Sorkin JD, Muller DC, Andres R. Longitudinal change in height of men and women: implications for interpretation of the body mass index: the Baltimore Longitudinal Study of Aging. Am J Epidemiol. 1999; 150: 969–77.
49. Stamler R, Ford CE, Stamler J. Why do lean hypertensive patients have higher mortality rates than other hypertensive patients? Findings of the hypertension detection and follow-up program. Hypertension. 1991; 17: 553–64.
50. Tao L., Gao E., Jiao X. Adiponectin cardioprotection after myocardial ischemia/reperfusion involves the reduction of oxidative/nitrative stress. Circulation. 2007; 115(11): 1408–16.
51. The WHO MONICA Project 1980–1990. http://www.thl.fi/publications/monica/index.html.
52. Trayhurn P., Wood I. S. Signalling role of adipose tissue: adipokines and inflammation in obesity. Biochemical Society Transactions. 2005; 33: 1078–1081.
53. Tuomilehto J. Body mass index and prognosis in elderly hypertensive patients: a report from the European Working Party on High Blood Pressure in the Elderly. Am J Med 1991; 90: 34S–41S.
54. Uretsky S, Messerli FH, Bangalore S. Obesity paradox in patients with hypertension and coronary artery disease. Am J Med. 2007; 120: 863–70.
55. Van den Beld A, Bots M, Janssen J. Endogenous hormones and carotid atherosclerosis in elderly men. Am J Epidemiol. 2003; 157: 25–31.
56. Von Eynatten M., Hamann A., Twardella D. Atherogenic dyslipidaemia but not total- and high-molecular weight adiponectin are associated with the prognostic outcome in patients with coronary heart disease. Eur Heart J. 2008; 29(10): 1307–15.
57. Wallace A.M., McMahon A.D., Packard C.J. et al. Plasma leptin and the risk of cardiovascular disease in the West Of Scotland Coronary Prevention Study (WOSCOPS). Circulation. 2001; 104: 3052–3056.
58. Wallerstedt S.M., Eriksson A.L., Niklason A. et al. Serum leptin and myocardial infarction in hypertension. Blood Press. 2004; 13: 243–246.
59. WHO Report «Burdens of Disease», 2008. http://www.who.int/healthinfo/global_burden_disease/2004_report_update/en/index.html
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, Obesity Paradox" – another look at the problem of cardiovascular disease. Obesity and metabolism. 2013;10(4):3-9. (In Russ.) https://doi.org/10.14341/omet201343-9
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