An obesity paradox: an inverse correlation between body mass index and atherosclerosis of the aorta

Brodsky, Sergey V.; Barth, Rolf F.; Mo, Xiaokui; Yıldız, Vedat; Allenby, Patricia; Ivanov, Iouri; Moore, Stephen; Hitchcock, Charles L.; Smith, Stephen M.; Sachak, Taha; Yao, Keluo; Ball, Matthew K.; Rosborough, Kelly; Olson, Zachary; Kiehl, Micah; Muni, Navin; Virmani, Renu

doi:10.1016/j.carpath.2016.09.002

Cited by 22 publications

(18 citation statements)

References 35 publications

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“…In other findings from this study, the association of a decreased risk of aortic atherosclerosis with increasing body mass index confirm a recent autopsy series that higher BMI was associated with less severe aortic atherosclerosis [39]. BMI was unrelated to coronary atherosclerosis in the current study.…”

Section: Discussionsupporting

confidence: 91%

Nicotine dependence as an independent risk factor for atherosclerosis in the National Lung Screening Trial

et al. 2019

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BackgroundAtherosclerosis and COPD are systemic inflammatory diseases that share common risk factors including cigarette smoking. A high level of nicotine dependence is emerging as a recently identified risk factor for pulmonary impairment, chronic obstructive pulmonary disease and tobacco-related cancers. We hypothesized that nicotine dependence is associated with the risk of atherosclerosis in long-term cigarette smokers.MethodsA nested case-control study was conducted within the National Lung Cancer Screening Trial- American College of Radiology Imaging Network. Cases were defined as having a new diagnosis of any type of atherosclerosis. Controls were matched on a 2:1 basis by age, sex, race, study center, smoking status, years of smoking, and frequency of smoking. Dependence was measured by the time to first cigarette after awakening (TTFC).ResultsThe study included 166 cases and 286 controls. Compared to participants who smoked within 5 min after waking, the risk of atherosclerosis for participants who smoked an hour or more after waking was borderline non-significant (odds ratio = 0.49, 95% confidence intervals [CI] 0.23, 1.00). Findings were similar for men and women. For aortic atherosclerosis, the corresponding odds ratio was 0.24 (95% CI 0.08, 0.69). Hypertension was associated with an increased risk and body mass index was associated with a decreased risk of aortic atherosclerosis. The TTFC was unrelated to coronary atherosclerosis.ConclusionsCompared to smoking immediately after waking, delaying an hour or more reduces the risk of aortic atherosclerosis even among long-term heavy smokers. Possible mechanisms that explain this association are intensity of smoking, inflammation and oxidative stress, and elevated lipid levels.

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Section: Discussionsupporting

confidence: 91%

Nicotine dependence as an independent risk factor for atherosclerosis in the National Lung Screening Trial

et al. 2019

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“…More recently, several studies underlined the so-called “obesity survival paradox” in patients suffering from acute myocardial infarction [ 2 , 7 – 9 ]. An analogous paradoxical influence of obesity was also demonstrated in an autopsy study on the aortic district [ 10 ].…”

Section: Introductionsupporting

confidence: 57%

“…These results have been corroborated by autopsy-related and histologic data revealing a lower incidence of coronary atherosclerosis in obese decedents [ 42 , 43 ]. According to Brodsky et al [ 10 ] morbid obesity seems to exert a protective effect also against developing severe aortic atherosclerosis, even if the pathogenetic mechanisms for such observation are yet to be explained.…”

Section: Discussionmentioning

confidence: 99%

The role of obesity in carotid plaque instability: interaction with age, gender, and cardiovascular risk factors

Rovella

Anemona

Cardellini

et al. 2018

Cardiovasc Diabetol

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BackgroundIn the last decade, several studies have reported an unexpected and seemingly paradoxical inverse correlation between BMI and incidence of cardiovascular diseases. This so called “obesity paradox effect” has been mainly investigated through imaging methods instead of histologic evaluation, which is still the best method to study the instability of carotid plaque. Therefore, the purpose of our study was to evaluate by histology the role of obesity in destabilization of carotid plaques and the interaction with age, gender and other major cerebrovascular risk factors.MethodsA total of 390 carotid plaques from symptomatic and asymptomatic patients submitted to endarterectomy, for whom complete clinical and laboratory assessment of major cardiovascular risk factors was available, were studied by histology. Patients with a BMI ≥ 30.0 kg/m2 were considered as obese. Data were analyzed by multivariate logistic regression and for each variable in the equation the estimated odds ratio (OR) was calculated.ResultsUnstable carotid plaque OR for obese patients with age < 70 years was 5.91 (95% CI 1.17–29.80), thus being the highest OR compared to that of other risk factors. Unstable carotid plaque OR decreased to 4.61 (95% CI 0.54–39.19) in males ≥ 70 years, being only 0.93 (95% CI 0.25–3.52) among women. When obesity featured among metabolic syndrome risk factors, the OR for plaque destabilization was 3.97 (95% CI 1.81–6.22), a significantly higher value compared to OR in non-obese individuals with metabolic syndrome (OR = 1.48; 95% CI 0.86–2.31). Similar results were obtained when assessing the occurrence of acute cerebrovascular symptoms.ConclusionsResults from our study appear to do not confirm any paradoxical effect of obesity on the carotid artery district. Conversely, obesity is confirmed to be an independent risk factor for carotid plaque destabilization, particularly in males aged < 70 years, significantly increasing such risk among patients with metabolic syndrome.

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“…In the present study, BMI showed the strongest correlation with AIP in entire population among various measures of general/central obesity (BMI, WC, WHtR and Ci). While Brodsky demonstrated an inverse relationship between obesity, generally determined by BMI, and subsequent aortic atherosclerosis, which has been termed the “obesity paradox” [ 22 ]. In fact, “obesity paradox” exists in diverse diseases including ESRD [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Visceral, general, abdominal adiposity and atherogenic index of plasma in relatively lean hemodialysis patients

et al. 2018

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BackgroundObesity is a well-established risk factor for atherosclerosis. However, it is unknown which measure of adiposity best relates to atherosclerosis in relatively lean maintenance hemodialysis (MHD) patients. We aimed to explore and compare the associations between different adiposity indices reflecting general, abdominal, visceral adiposity and arteriosclerosis risk with atherogenic index of plasma(AIP) in relatively lean MHD patients.MethodsWe conducted a multicenter, cross-sectional study in Guizhou Province, Southwest China. General/abdominal adiposity indices like body mass index (BMI), waist circumference(WC), waist-height ratio(WHtR), conicity index (Ci) and visceral obesity indices including visceral adiposity index (VAI), lipid accumulation product (LAP) and the hypertriglyceridemic waist phenotype (HW phenotype) were recorded. Univariate and multivariate linear regression models were used.ResultsAll adiposity indices correlated positively with AIP in univariate analysis both in men and women except for Ci. After adjustment for age and traditional atherosclerosis risk factors, BMI, WC, WHtR, VAI and LAP still had associations with AIP both in men (β = 0.265, 0.153, 0.16, 0.788 and 0.74, respectively, all P < 0.001) and women (β = 0.34,0.199, 0.21, 0.83 and 0.74, respectively, all P < 0.001). After further adjustment for BMI, associations between AIP and VAI, LAP remained significant, but associations between WC, WHtR and AIP disappeared.ConclusionsThe HW phenotype, VAI, and LAP, validated and convenient markers of visceral obesity, were superior to classical anthropometric general/ abdominal adiposity indices for atherosclerosis risk assessment, especially in relatively lean MHD patients aged 40 years or older.

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An obesity paradox: an inverse correlation between body mass index and atherosclerosis of the aorta

Cited by 22 publications

References 35 publications

Nicotine dependence as an independent risk factor for atherosclerosis in the National Lung Screening Trial

Nicotine dependence as an independent risk factor for atherosclerosis in the National Lung Screening Trial

The role of obesity in carotid plaque instability: interaction with age, gender, and cardiovascular risk factors

Visceral, general, abdominal adiposity and atherogenic index of plasma in relatively lean hemodialysis patients

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