Obesity Paradox in Aging: From Prevalence to Pathophysiology☆
Section snippets
Epidemiology, and clinical evidence for obesity paradox in heart failure (HF)
Obesity has reached an epidemic proportion and imposed substantial risks on both metabolic and cardiovascular (CV) diseases (CVD), contributing to the increased premature mortality.1., 2., 3., 4. Overweight and obesity adversely affect CV function and serve as an independent risk factor for both systolic and diastolic heart dysfunction, resulting in HF.4., 5., 6., 7. Several scenarios including oxidative stress, apoptosis, autophagy failure, lipotoxicity, inflammation, hemodynamic change,
Confounding influences of obesity paradox – focusing on aging
A number of confounding factors were implicated to influence the CV outcomes in obesity, thus affecting obesity paradox and prognosis of CVD. For example, gender, nutritional status, aging and therapeutic strategies, such as CRF and weight loss may all contribute to the presentation of obesity paradox.14,25,28 Here we will discuss gender, socioeconomic, nutrition and aging with a focus on how aging may alter the clinical prognosis.
Obesity paradox– pathophysiological aspects of aging, adiposity and CV health
Although obesity paradox may be affected by various factors such as age, gender, etiology of CVD and comorbidities, the pathophysiology underscoring the heterogeneous impact of aging on adiposity and CVD outcomes in obesity paradox remains largely obscure. Aging is an important independent risk factor for cardiometabolic incidents, resulting in unfavorable changes in CV system including cardiac remodeling, decrease in exercise capacity and pump function, endothelial dysfunction and vascular
Intervention targeting obesity in obesity paradox – weight loss and dietary restriction
For management of overweight and obese patients with CVD, it is suggested that clinical care should be focused on improvement and maintenance of physical function and quality of life as opposed to the prevention of obesity-related medical problems in younger aged patients.27 Although weight loss is beneficial for cardiac geometry and function, as well as symptom control in HF, definitive clinical guidelines are still lacking for the optimal body composition in patients with HF, especially in
Future perspectives, challenges and conclusions
Obesity paradox refers to the association between obesity (in particular class 1 obesity) and better survival with a given disease, such as HF or CHD. Because the data to support the obesity paradox are exclusively from clinical observations, it is still uncertain whether the obesity paradox is an artifact from observational studies. Paradoxical observations cause vexing clinical and epidemiological presentations to result in causal relationships. Compelling evidence has indicated a unique role
Statement of conflict of interest
There is no conflict of interest of any of the listed authors.
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The link between obesity and aging - insights into cardiac energy metabolism
2023, Mechanisms of Ageing and DevelopmentSex differences in the relationship between body mass index and outcome in myocardial infarction
2023, American Journal of the Medical SciencesInterplay between obesity and aging on myocardial geometry and function: Role of leptin-STAT3-stress signaling
2023, Biochimica et Biophysica Acta - General SubjectsElevated body mass index increases the risk of cardiovascular events in hypertensive patients accompanied with obstructive sleep apnea: A cohort study
2022, Obesity Research and Clinical PracticeDifferential associations between body mass index and outcome in different age groups in patients with myocardial infarction
2022, Indian Heart JournalCitation Excerpt :Aging is associated with fat redistribution and obesity, while obesity may promote premature aging.5 Although obesity, body fat percentage, and fat distribution change with age,4 data on the possible association between age and BMI and outcome in patients with MI who have undergone percutaneous coronary intervention (PCI) are extremely sparse, inconclusive, contradictory, and sometimes controversial, and long-term data are lacking.5,6 We aimed to investigate the possible differential influences of BMI on 30-day and long-term outcomes in different age categories in patients with MI who underwent PCI.
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Statement of Conflict of Interest: see page 187.