Author + information
- Amir Emami, MD,
- Marcelo R. Dos Santos, PhD,
- Stefan D. Anker, MD, PhD,
- Stephan von Haehling, MD, PhD and
- Anja Sandek, MD, PhD∗ ()
- ↵∗Department of Cardiology and Pulmonology, University Medical Center Göttingen, Heart Center Göttingen, Robert Koch Strasse 40, 37075 Göttingen, Germany
Several studies demonstrate the presence of an “obesity paradox” among patients with several chronic diseases, and this obesity paradox shows that lower (rather than higher) body mass index is a risk factor for increased mortality. In particular, the presence of a significant degree of obesity (i.e., at least up to a body mass index of 30 to 35 kg/m2) is associated with lower mortality (1–3). However, when Vest and colleagues. (4) analyzed their data by gender, they surprisingly found that well-established obesity paradox is valid for women but not for men. Most studies with a considerable amount of patients could not show such a gender-specific difference in obesity paradox (1,2).
Although Vest et al. (4) have adjusted their data for a variety of potential cofounders, they did not adjust for coronary artery disease (CAD). It should be considered that CAD was more frequent in men than women (4). This may have had a significant impact on the survival rate in the male study cohort.
In this regard, implementation of other established survival markers in heart failure, such as N-terminal pro–B-type natriuretic peptide, as von Haehling et al. (5) discussed in their article, would be of help to shed more light on the conflicting results in this study.
The study protocol by Vest et al. (4) allowed cardiopulmonary exercise testing using either treadmill for most patients and bicycle exercise in a minority of patients. However, it is well-known that the results differ significantly depending on exercise method, and we question the validity of this mix of test methods. Did the authors adjust for this effect? Because values gained from bicycle and treadmill are not directly comparable, how did the authors overcome these differences?
Please note: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- American College of Cardiology Foundation
- Fonarow G.C.,
- Srikanthan P.,
- Costanzo M.R.,
- Cintron G.B.,
- Lopatin M.,
- ADHERE Scientific Advisory Committee and Investigators
- Vest A.R.,
- Wu Y.,
- Hachamovitch R.,
- Young J.B.,
- Cho L.S.