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LETTER TO THE EDITOR
Year : 2013  |  Volume : 12  |  Issue : 3  |  Page : 191  

"Obesity paradox" or methodologic error


Department of Cardiology, Medicana International Ankara Hospital, Sogutozu, Cankaya, Ankara, Turkey

Date of Web Publication5-Sep-2013

Correspondence Address:
Ali Cevat Tanalp
Department of Cardiology, Medicana International Ankara Hospital, Sogutozu, Cankaya-06520, Ankara
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1596-3519.117633

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How to cite this article:
Tanalp AC. "Obesity paradox" or methodologic error. Ann Afr Med 2013;12:191

How to cite this URL:
Tanalp AC. "Obesity paradox" or methodologic error. Ann Afr Med [serial online] 2013 [cited 2020 Aug 9];12:191. Available from: http://www.annalsafrmed.org/text.asp?2013/12/3/191/117633

Sir,

Oyedeji at et al., [1] reported positive correlation between body mass index (BMI) and conventional echocardiographic parameters. [1] Left ventricular systolic functions were higher in obese subjects and authors concluded that cardiac functions were better in obese subjects which is compatible with obesity paradox. There is a strong relationship between obesity and major cardiovascular risk factors such as diabetes, hypertension, and dyslipidemia. However, obese patients with myocardial infarction (MI) have lower mortality which is defined as obesity paradox. [2] Conventional ejection phase indices are largely volume-dependent and are very much influenced from preload and afterload. The circulation is hyperdynamic in the obese population because of the increased metabolic demand and blood volume. Preload and afterload are increased as a result of the elevated peripheral vascular resistance. [3] The preservation of preload dependent systolic function parameters in the early phases of obesity is demonstrated by Garavaglia et al. [4] In a previously presented study by me and my colleagues left ventricular systolic functions were similarly elevated with conventional methods, however reevaluation with tissue Doppler study demonstrated systolic dysfunction. [5] Although standard echocardiographic methods failed to identify systolic dysfunction in the obese patients, the systolic myocardial velocity (Sm) was decreased by tissue Doppler imaging in the moderately and significantly obese subjects. [5] In my opinion this study should be verified by novel advanced echocardiographic methods.

 
   References Top

1.Oyedeji AT, Balogun MO, Akintomide AO, Sunmonu TA, Adebayo RA, Ajayi OE. The "obesity paradox" in Nigerians with heart failure. Ann Afr Med 2012;11:212-6.  Back to cited text no. 1
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2.Das SR, Alexander KP, Chen AY, Powell-Wiley TM, Diercks DB, Peterson ED, et al. Impact of body weight and extreme obesity on the presentation, treatment, and in-hospital outcomes of 50,149 patients with ST-Segment elevation myocardial infarction results from the NCDR (National Cardiovascular Data Registry). J Am Coll Cardiol 2011;58:2642-50.  Back to cited text no. 2
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3.de Divitiis O, Fazio S, Petitto M, Maddalena G, Contaldo F, Mancini M. Obesity and cardiac function. Circulation 1981;64:477-82.  Back to cited text no. 3
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4.Garavaglia GE, Messerli FH, Nunez BD, Schmieder RE, Grossman E. Myocardial contractility and left ventricular function in obese patients with essential hypertension. Am J Cardiol 1988;62:594-7.  Back to cited text no. 4
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5.Tanalp AC, Bitigen A, Cevik C, Demir D, Ozveren O, Tigen K, et al. The role of tissue Doppler study in the assessment of left ventricular dysfunction in obesity. Acta Cardiol 2008;63:541-6.  Back to cited text no. 5
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