Impact of Cardiorespiratory Fitness on the Obesity Paradox in Patients With Heart Failure

Lavie, Carl J.; Cahalin, Lawrence P.; Chase, Paul; Myers, Jonathan; Bensimhon, Daniel; Peberdy, Mary Ann; Ashley, Euan A.; West, Erin; Forman, Daniel E.; Guazzi, Marco; Arena, Ross

doi:10.1016/j.mayocp.2012.11.020

Cited by 199 publications

(124 citation statements)

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“…9 In a study of ≈10 000 patients with CHD followed for close to 15 years, McAuley et al 133 using ACLS data demonstrated that those with moderate to high levels of cardiorespiratory fitness, defined as not being in the bottom tertile of cardiorespiratory fitness for age and sex, have a good prognosis, regardless of BMI, WC, or BF%, whereas in those with low cardiorespiratory fitness, an obesity paradox was present during long-term follow up, meaning that those with low cardiorespiratory fitness and the lowest categories of body composition (BMI, WC, and BF%) have a worse CVD-and all-cause mortality than did heavier CHD patients. 134 Likewise, Lavie et al 135 demonstrated the same impact of cardiorespiratory fitness to alter the obesity paradox in 2066 patients with systolic HF during 3-year follow-up and those with poor cardiorespiratory fitness, defined as peak Vo 2 < 14 mL/kg per minute, a strong obesity paradox was present, meaning that those with BMI≥30 kg/m 2 had the best survival, followed by overweight HF patients, and the worst survival occurred in those with normal BMI (18.5-25 kg/m 2 ; underweight patients, who almost have the worst survival, were excluded). On the contrary, the HF patients with relatively preserved cardiorespiratory fitness (peak Vo 2 ≥ 14 mL/kg per minute) had a good prognosis regardless of their BMI.…”

Section: Obesity Paradox In Patients With Cvdmentioning

confidence: 98%

Obesity and Cardiovascular Disease

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Lavie

Blair

2016

Circulation Research

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926

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T here is overall agreement in the scientific and clinical community that obesity is one of the major public health problems of this century. The first documented reports on obesity date from the end of the 19th century and the beginning of the 20th century.1-3 From these days to date, >57 000 articles have been published in PubMed including the term obesity in the title, with these figures being 3× larger when searching by obesity also in the abstract. Figure 1 graphically Abstract: The prevalence of obesity has increased worldwide over the past few decades. In 2013, the prevalence of obesity exceeded the 50% of the adult population in some countries from Oceania, North Africa, and Middle East. Lower but still alarmingly high prevalence was observed in North America (≈30%) and in Western Europe (≈20%). These figures are of serious concern because of the strong link between obesity and disease. In the present review, we summarize the current evidence on the relationship of obesity with cardiovascular disease (CVD), discussing how both the degree and the duration of obesity affect CVD. Although in the general population, obesity and, especially, severe obesity are consistently and strongly related with higher risk of CVD incidence and mortality, the one-sizefits-all approach should not be used with obesity. There are relevant factors largely affecting the CVD prognosis of obese individuals. In this context, we thoroughly discuss important concepts such as the fat-but-fit paradigm, the metabolically healthy but obese (MHO) phenotype and the obesity paradox in patients with CVD. About the MHO phenotype and its CVD prognosis, available data have provided mixed findings, what could be partially because of the adjustment or not for key confounders such as cardiorespiratory fitness, and to the lack of consensus on the MHO definition. In the present review, we propose a scientifically based harmonized definition of MHO, which will hopefully contribute to more comparable data in the future and a better understanding on the MHO subgroup and its CVD prognosis. (Circ Res.

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Section: Obesity Paradox In Patients With Cvdmentioning

confidence: 98%

Obesity and Cardiovascular Disease

Ortega

Lavie

Blair

2016

Circulation Research

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926

603

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“…When estimated by BMI, obesity is associated with a favorable outcome in patients with HF, a phenomenon that is referred to as the obesity paradox 130, 131, 132, 133, 134, 135, 136. However, when obesity is assessed by indices of visceral obesity, such as waist circumference and waist‐hip ratio, the obesity paradox is no longer apparent 137.…”

Section: Obesity Phenotypementioning

confidence: 99%

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

Samson

Jaiswal

Ennezat

et al. 2016

JAHA

110

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“…This reflects evidence from the general population (including the elderly) and from peri-operative studies that the overweight have a lower mortality than both underweight (BMI < 20 kg.m À2 ) and 'normal' weight patients (BMI 20-25 kg.m À2 ) [42][43][44][45][46].…”

mentioning

confidence: 84%

Pre‐operative co‐morbidity and postoperative survival in the elderly: beyond one lunar orbit

Carlisle

2013

Anaesthesia

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SummaryMortality is a good measure of killing, but it is a poor measure of cure, palliation or the maintenance of function. Nevertheless, it has remained the primary metric of hospital care for 200 years. This article discusses the factors that contribute to mortality risk and survival trajectories, as well as the increasing recognition that surgery kills for months after the last suture is tied. This article discusses how disparate factors can usefully combine to generate an 'elderly' group with a monthly mortality in excess of 1% and a median life expectancy less than 3.5 years. A downloadable spreadsheet is provided that combines risk factors to generate mortality risks and their associated survival curves, emphasising the importance of looking beyond one postoperative month. If the function of a hospital were to kill the sick, statistical comparisons of this nature would be admissible.-Florence Nightingale, 1859 [1] Mortality is an insensitive measure of care: most patients survive the postoperative period, whilst (perhaps) many observed deaths are not associated with poor care. We should concentrate on the living, not the dead. Unfortunately, information on the effect surgery has on people's lives is scarce, in comparison with how often it kills them. This paper discusses how to estimate the chance that someone will die and how much this might change following surgery, but in so doing, we might reflect on Florence Nightingale's observation that mortality is an excellent measure of performance only for those trying to kill. Chance (at least in part) determines survival and death, which can be estimated using certain characteristics throughout adulthood: age; sex; historical morbidity; and physiological function [2][3][4][5][6][7][8][9][10][11][12]. The latter two characteristics are meant in their broadest sense, so that together they might accommodate variables that are, or might be, independently associated with survival. For instance, socioeconomic status is an historical characteristic that confers morbidity and mortality risks, whereas brain natriuretic peptide (BNP) is a marker of physiological function that might be shown to have an independent prognostic value. Crucially, variables used in the calculation should have a known independent effect on long-term survival in the general, non-surgical population, so that all the purposes of pre-operative mortality estimation are served (see below). Variables, such as BNP, have yet to declare their value in promoting the precision of perioperative prognostication, because their relationship with general survival has been inadequately described.It is one's risk of death, rather than one's proximity to birth, that determines the trajectory of one's remain-

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Impact of Cardiorespiratory Fitness on the Obesity Paradox in Patients With Heart Failure

Abstract: These results indicate that FIT modifies the relationship between BMI and survival. Thus, assessing the obesity paradox in systolic HF may be misleading unless FIT is considered.

Cited by 199 publications

References 44 publications

Obesity and Cardiovascular Disease

Obesity and Cardiovascular Disease

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

Pre‐operative co‐morbidity and postoperative survival in the elderly: beyond one lunar orbit

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