The “overweight paradox” in the prognosis of acute coronary syndrome for patients with heart failure—A truth for all? A 10-year follow-up study

Kouvari, Matina; Chrysοhoou, Christina; Tsiamis, E.; Kosyfa, Hara; Kalogirou, Lemonia; Filippou, Amalia; Iosifidis, Stelios; Aggelopoulos, Panagiotis; Pitsavos, Christos; Tousoulis, Dimitris

doi:10.1016/j.maturitas.2017.05.003

Cited by 14 publications

(13 citation statements)

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“…An additional finding here was that mostly overweight women with moderate SMI presented the lowest CVD risk. Meanwhile, the obtained knowledge is that BMI-related paradoxical association is more evident in women where a non-linear trend has been suggested in advanced age or established chronic diseases [21,22]. The added value of the present work is related with highlights that women's "overweight paradox" in advanced age may be attributed not only to their resistance to adiposity but also to sex-specific responses of muscle mass.…”

Section: Discussionmentioning

confidence: 59%

Predicted Skeletal Muscle Mass and 4-Year Cardiovascular Disease Incidence in Middle-Aged and Elderly Participants of IKARIA Prospective Epidemiological Study: The Mediating Effect of Sex and Cardiometabolic Factors

et al. 2020

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The sex-specific effect of skeletal muscle mass (SMM) index (SMI) on 4-year first fatal/non-fatal cardiovascular disease (CVD) event in free-of-disease individuals was examined. In 2009, n = 1411 inhabitants (mean age = 64(12)) from Ikaria were selected. Follow-up was performed in 2013. SMI was created to reflect SMM through appendicular skeletal muscle mass (indirectly calculated through formulas) divided by body mass index (BMI). Fifteen and six tenths percent of participants exhibited CVD (19.8% in men/12% in women, p = 0.002). Significant U-shape trends were observed in participants >65 years old and women irrespective to age confirmed through multi-adjusted Cox regression analysis; in age >65 years, Hazard Ratio (HR)(2nd vs. 1st SMI tertile) = 0.80, 95% Confidence Interval (95%CI) (0.45, 0.96) and in women HR(2nd vs. 1st SMI tertile) = 0.71, 95% CI (0.33, 0.95), while, as for the 3rd SMI tertile, no significant trends were observed. Mediation analysis revealed that mediators of the aforementioned associations in men were the arterial distensibility and total testosterone, while, in women, inflammation, insulin resistance, and arterial distensibility. High SMM accompanied by obesity may not guarantee lower CVD risk. Specific cardiometabolic factors seem to explain this need for balance between lean and fat mass.

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Section: Discussionmentioning

confidence: 59%

Predicted Skeletal Muscle Mass and 4-Year Cardiovascular Disease Incidence in Middle-Aged and Elderly Participants of IKARIA Prospective Epidemiological Study: The Mediating Effect of Sex and Cardiometabolic Factors

et al. 2020

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“…76,77 In females, a paradoxical association between BMI and CVD prognosis has been suggested. 78 Kidney dysfunction defined by the urinary albumin excretion and the estimated glomerular filtration rate has been suggested as even more applicable in case of secondary prevention of sudden death in women, increasing the discriminatory ability of ejection fraction. 53 Depression, anxiety, and stress are strongly underscored as factors with high prognostic ability, especially in women.…”

Section: Resultsmentioning

confidence: 99%

“…In EUROASPIRE III, these psychosocial parameters were related to increased BMI, abnormal glycemic status, and poor quality of life probably due to discouraging patient adherence to treatment and lifestyle modification. 78 –82 Considering the large economic and disability burden, a better clarification of such issues, separately for males and females, will contribute to the development of a postdischarge screening system, which will orient the specific targets and the intensity of the applied rehabilitation program.…”

Section: Resultsmentioning

confidence: 99%

Challenges in Sex- and Gender-Centered Prevention and Management of Cardiovascular Disease: Implications of Genetic, Metabolic, and Environmental Paths

et al. 2018

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The recognition of cardiovascular disease (CVD) as a "male" privilege has been a commonly held concept. However, emerging data describe another reality. Heterogeneities have been convincingly demonstrated regarding CVD manifestations, risk factor burden, and prognosis between males and females. The aim of the present narrative review was to highlight sex- and gender-related discrepancies in primary and secondary CVD prevention, underscoring plausible underlying mechanisms. Manifestation of CVD in women is characterized by atypical symptoms/signs and inadequately studied pathophysiology features challenging accurate diagnosis and effective treatment. Regarding CVD risk assessment, the burden and effect size of conventional, novel, and female-specific risk factors needs better clarification. Hitherto outcomes are nonconsistent, while most importantly, the interpretation of the attendant metabolic paths remains a challenge; the interactions among genetic, metabolic, and environmental factors are of high complexity regulated by genomic and nongenomic sex hormones effects. To deal with these key points, the National Institutes of Health currently calls upon investigators to provide a sex- and gender-specific reporting in all health research hypotheses. The implementation of high-quality studies addressing these issues is an imperative need to maximize cost-effectiveness in prevention and management strategies.

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“…High rates of combined overweight and obesity have also been recorded for children and adolescents, e.g., 20–25% in Latin America [2], 40% in southern Europe, and 10% in northern Europe [3]. In addition, obesity has been shown to be associated with increased chance of mortality [4], whereas overweight has been linked to diseases such as hypertension, hypercholesterolemia, and diabetes [5,6]. Overweight and obesity did not only have implications for health, but also had an important financial impact on increasing health care expenditures [7].…”

Section: Introductionmentioning

confidence: 99%

The Effect of Body Mass Index on Acute Cardiometabolic Responses to Graded Exercise Testing in Children: A Narrative Review

Nikolaidis¹,

Kintziou

Georgoudis

et al. 2018

Sports

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Although the beneficial role of exercise for health is widely recognized, it is not clear to what extent the acute physiological responses (e.g., heart rate (HR) and oxygen uptake (VO2)) to a graded exercise test are influenced by nutritional status (i.e., overweight vs. normal-weight). Therefore, the main objectives of the present narrative review were to examine the effect of nutritional status on acute HR, and VO2 responses of children to exercise testing. For this purpose, we examined existing literature using PubMed, ISI, Scopus, and Google Scholar search engines. Compared with their normal-body mass index (BMI) peers, a trend of higher HRrest, higher HR during submaximal exercise testing, and lower HRmax was observed among overweight and obese children (according to BMI). Independent from exercise mode (walking, running, cycling, or stepping), exercise testing was metabolically more demanding (i.e., higher VO2) for obese and overweight children than for their normal-weight peers. Considering these cardiometabolic differences according to BMI in children might help exercise specialists to evaluate the outcome of a graded exercise test (GXT) (e.g., VO2max, HRmax) and to prescribe optimal exercise intensity in the context of development of exercise programs for the management of body mass.

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The “overweight paradox” in the prognosis of acute coronary syndrome for patients with heart failure—A truth for all? A 10-year follow-up study

Cited by 14 publications

References 32 publications

Predicted Skeletal Muscle Mass and 4-Year Cardiovascular Disease Incidence in Middle-Aged and Elderly Participants of IKARIA Prospective Epidemiological Study: The Mediating Effect of Sex and Cardiometabolic Factors

Predicted Skeletal Muscle Mass and 4-Year Cardiovascular Disease Incidence in Middle-Aged and Elderly Participants of IKARIA Prospective Epidemiological Study: The Mediating Effect of Sex and Cardiometabolic Factors

Challenges in Sex- and Gender-Centered Prevention and Management of Cardiovascular Disease: Implications of Genetic, Metabolic, and Environmental Paths

The Effect of Body Mass Index on Acute Cardiometabolic Responses to Graded Exercise Testing in Children: A Narrative Review

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