Reverse epidemiology of conventional cardiovascular risk factors in patients with chronic heart failure.
By Kamyar Kalantar-Zadeh, G. Block, T. Horwich, G. Fonarow. Journal of the American College of Cardiology, 2004
725 citations recorded by the source corpus.
Traditional risk factors of a poor clinical outcome and mortality in the general population, including body mass index (BMI), serum cholesterol, and blood pressure (BP), are also found to relate to outcome in patients with chronic heart failure (CHF), but in an opposite direction. Obesity, hypercholesterolemia, and high values of BP have been demonstrated to be associated with greater survival among CHF patients. These findings are in contrast to the well-known associations of over-nutrition, hypercholesterolemia, and hypertension with a poor outcome in the general population. The association between traditional cardiovascular risk factors and an adverse clinical outcome in CHF patients is referred to as "reverse epidemiology." The mechanisms for this inverse association in CHF is not clear. There are other populations with a similar risk factor reversal phenomenon, including patients with end-stage renal disease receiving dialysis, those with advanced malignancies, and individuals with advanced age. Several possible causes are hypothesized: the time discrepancy of the competing risk factors may play a role; the presence of the "malnutrition-inflammation complex syndrome" in CHF patients may explain the existence of reverse epidemiology; and a decreased level of lipoprotein molecules may distort their endotoxin-scavenging role, predisposing CHF patients with a low serum cholesterol level to inflammatory consequences of endotoxemia. It is possible that new goals for such traditional risk factors as BMI, serum cholesterol, and BP should be developed for CHF. Reverse epidemiology of conventional cardiovascular risk factors is observed in CHF and may have a bearing on the management of these patients; thus, it deserves further investigation.
Subfields: Cardiology and Cardiovascular Medicine, Physiology
View Paper: https://www.semanticscholar.org/paper/056342c57ea996f91709b298cb5b3dd9d49d2e2b
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In Cardiology and Cardiovascular Medicine
Citations in the corpus
- Body mass index and mortality in heart failure: a meta-analysis. (2008, background): “, obesity, which has been termed the obesity paradox or reverse epidemiology.(2) In addition, although wasting (cachexia) appears to be a poor prognostic factor in HF,(3) small observational studies have demonstrated improvements in left ventricular function and symptoms in patients with HF after in”
- Survival advantages of obesity in dialysis patients. (2005, background): “Cardiac diseases such as heart failure or other comorbid conditions may engender anorexia and, if sufficiently severe, may independently induce protein and muscle wasting, which is also known as cardiac cachexia (12, 108).”