Review
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Oct 26, 2015; 7(10): 603-608
Published online Oct 26, 2015. doi: 10.4330/wjc.v7.i10.603
“Obesity paradox” in coronary artery disease
Ibrahim Akin, Christoph A Nienaber
Ibrahim Akin, Department of Cardiology, Universitätsmedizin Mannheim, 68167 Mannheim, Germany
Christoph A Nienaber, Cardiology and Aortic Centre, the Royal Brompton Hospital and Harefield Trust, London SW3 6NP, United Kingdom
Author contributions: Both authors contributed to this manuscript.
Conflict-of-interest statement: No conflict of interest for all authors.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Christoph A Nienaber, Professor, Cardiology and Aortic Centre, the Royal Brompton Hospital and Harefield Trust, Sydney Street, London SW3 6NP, United Kingdom. c.nienaber@rbht.nhs.uk
Telephone: +44-0207-3528121 Fax: +44-0207-3518634
Received: May 25, 2015
Peer-review started: May 27, 2015
First decision: July 10, 2015
Revised: August 4, 2015
Accepted: August 20, 2015
Article in press: August 21, 2015
Published online: October 26, 2015
Processing time: 162 Days and 7.8 Hours
Abstract

Obesity used to be among the more neglected public health problems, but has unfolded as a growing medical and socioeconomic burden of epidemic proportions. Morbid obesity is linked to traditional cardiovascular risk factors like, hypertension, hyperlipidemia and diabetes, and suspected to incur increased morbidity and mortality in the Western and even third world populations. This patient cohort is also at greater risk to develop coronary artery disease. Recent population-based registries revealed that 43% and 24% of all cases of coronary revascularization were carried out in overweight and obese patients, respectively. However, despite evidence of a positive correlation between obesity and increased cardiovascular morbidity, some authors have described a better clinical outcome in overweight and obese patients, a phenomenon they coined “obesity paradoxon”. Thus, there is an ongoing debate in light of conflicting data and the possibility of confounding bias causing misconception and challenging the “obesity paradox”. In this review article we present the current evidence and throughly discuss the validity of the “obesity paradoxon” in a variety of clinical settings.

Keywords: Coronary stent; Obesity paradox; Mortality; Body mass index

Core tip: Obesity is one of the leading health problems within the last years and is associated with several cardiovascular risk factors resulting in increased prevalence of coronary artery disease as well as atherosclerotic disease in head vessels and peripheral artery system. Despite these positive correlations there are reports describing a protective effect in patients undergoing coronary revascularization. This review will enlight the potential causes and bias regarding this “obesity paradoxon” in several clinical setting and will present the latest data.