The obesity paradox in men with coronary heart disease and heart failure: The role of muscle mass and leptin |
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Authors: | S. Goya Wannamethee A. Gerald Shaper Peter H. Whincup Lucy Lennon Olia Papacosta Naveed Sattar |
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Affiliation: | 1. Department of Primary Care and Population Health, UCL, London, UK;2. Department of Population Health Sciences and Education, St George''s, University of London, London, UK;3. Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK |
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Abstract: | AimsWe have investigated the role of muscle mass, natriuretic peptides and adipokines in explaining the obesity paradox.BackgroundThe obesity paradox relates to the association between obesity and increased survival in patients with coronary heart disease (CHD) or heart failure (HF).MethodsProspective study of 4046 men aged 60–79 years followed up for a mean period of 11 years, during which 1340 deaths occurred. The men were divided according to the presence of doctor diagnosed CHD and HF: (i) no CHD or HF ii), with CHD (no HF) and (iii) with HF.ResultsOverweight (BMI 25–9.9 kg/m2) and obesity (BMI ≥ 30 kg/m2) were associated with lower mortality risk compared to men with normal weight (BMI 18.5–24.9 kg/m2) in those with CHD [hazards ratio (HR) 0.71 (0.56,0.91) and 0.77 (0.57,1.04); p = 0.04 for trend] and in those with HF [HR 0.57 (0.28,1.16) and 0.41 (0.16,1.09; p = 0.04 for trend). Adjustment for muscle mass and NT-proBNP attenuated the inverse association in those with CHD (no HF) [HR 0.78 (0.61,1.01) and 0.96 (0.68,1.36) p = 0.60 for trend) but made minor differences to those with HF [p = 0.05]. Leptin related positively to mortality in men without HF but inversely to mortality in those with HF; adjustment for leptin abolished the BMI mortality association in men with HF [HR 0.82 (0.31,2.20) and 0.99 (0.27,3.71); p = 0.98 for trend].ConclusionThe lower mortality risk associated with excess weight in men with CHD without HF may be due to higher muscle mass. In men with HF, leptin (possibly reflecting cachexia) explain the inverse association. |
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Keywords: | NT-proBNP, N-terminal pro-brain natriuretic peptide HF, Heart failure MI, Myocardial infarction CHD, Coronary heart disease CRP, C-reactive protein WC, Waist circumference BMI, Body mass index MAMC, Mid arm muscle circumference |
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