CLINICAL RESEARCH: VIEWPOINT
Reverse epidemiology of conventional cardiovascular risk factors in patients with chronic heart failure
Kamyar Kalantar-Zadeh, MD, MPH* ,
Gladys Block, PhD,
Tamara Horwich, MD and
Gregg C. Fonarow, MD, FACC,*
* Harbor-UCLA Medical Center, Torrance, USA
University of California, Berkley, School of Public Health, Berkeley, USA
Ahmanson-UCLA Cardiomyopathy Center, Los Angeles, California, USA
Manuscript received September 7, 2003;
revised manuscript received October 30, 2003,
accepted November 4, 2003.
* Reprint requests and correspondence: Dr. Gregg C. Fonarow, Ahmanson-UCLA Cardiomyopathy Center, Division of Cardiology, University of California at Los Angeles, 47-123 CHS, 10833 LaConte Avenue, Los Angeles, California 90095-1679, USA.
gfonarow{at}mednet.ucla.edu
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.
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Abbreviations and Acronyms
| | BMI | = body mass index | | BP | = blood pressure | | CHF | = chronic heart failure | | ESRD | = end-stage renal disease | | MICS | = malnutrition–inflammation complex syndrome | | NYHA | = New York Heart Association | | PEM | = protein-energy malnutrition | | TNF | = tumor necrosis factor |
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|
|
|
|
|
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|
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|
|
|
|
|
|
|
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1265 - 1272.
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[Full Text]
[PDF]
|
|
|
|
|
|
|
R. P. Vivo, S. R. Krim, C. Cevik, and R. M. Witteles
Heart failure in hispanics.
J. Am. Coll. Cardiol.,
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53(14):
1167 - 1175.
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|
|
|
|
|
|
|
G. C. Fonarow
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30(5):
625 - 625.
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|
|
|
|
|
|
|
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119(5):
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|
|
|
|
|
|
|
C. Zoccali
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|
|
|
|
|
|
|
G. C. Fonarow
Smoker's paradox in heart failure: might asymmetric dimethylarginine be the possible explanation?: reply
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29(23):
2949 - 2949.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Sauvaget, K. Ramadas, G. Thomas, J. Vinoda, S. Thara, and R. Sankaranarayanan
Body mass index, weight change and mortality risk in a prospective study in India
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37(5):
990 - 1004.
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[Full Text]
[PDF]
|
|
|
|
|
|
|
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NT-proBNP has a high negative predictive value to rule-out short-term cardiovascular events in patients with diabetes mellitus
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29(18):
2259 - 2264.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. T. Abraham, G. C. Fonarow, N. M. Albert, W. G. Stough, M. Gheorghiade, B. H. Greenberg, C. M. O'Connor, J. L. Sun, C. W. Yancy, J. B. Young, et al.
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July 29, 2008;
52(5):
347 - 356.
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[Full Text]
[PDF]
|
|
|
|
|
|
|
T. B. Horwich and G. C. Fonarow
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July 29, 2008;
118(5):
469 - 471.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. M. Dekker, T. Funahashi, G. Nijpels, S. Pilz, C. D. A. Stehouwer, M. B. Snijder, L. M. Bouter, Y. Matsuzawa, I. Shimomura, and R. J. Heine
Prognostic Value of Adiponectin for Cardiovascular Disease and Mortality
J. Clin. Endocrinol. Metab.,
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93(4):
1489 - 1496.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. B. Liggett, R. J. Kelly, R. R. Parekh, S. J. Matkovich, B. J. Benner, H. S. Hahn, F. M. Syed, A. S. Galvez, K. L. Case, N. McGuire, et al.
A functional polymorphism of the G{alpha}q (GNAQ) gene is associated with accelerated mortality in African-American heart failure
Hum. Mol. Genet.,
November 15, 2007;
16(22):
2740 - 2750.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Mosterd and A. W Hoes
Clinical epidemiology of heart failure
Heart,
September 1, 2007;
93(9):
1137 - 1146.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Kenchaiah, S. J. Pocock, D. Wang, P. V. Finn, L. A.M. Zornoff, H. Skali, M. A. Pfeffer, S. Yusuf, K. Swedberg, E. L. Michelson, et al.
Body Mass Index and Prognosis in Patients With Chronic Heart Failure: Insights From the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) Program
Circulation,
August 7, 2007;
116(6):
627 - 636.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Tsutamoto, T. Tanaka, H. Sakai, C. Ishikawa, M. Fujii, T. Yamamoto, and M. Horie
Total and high molecular weight adiponectin, haemodynamics, and mortality in patients with chronic heart failure
Eur. Heart J.,
July 2, 2007;
28(14):
1723 - 1730.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Alakhras, P. A. Decker, H. F. Nadrous, M. Collazo-Clavell, and J. H. Ryu
Body Mass Index and Mortality in Patients With Idiopathic Pulmonary Fibrosis
Chest,
May 1, 2007;
131(5):
1448 - 1453.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. Kalantar-Zadeh, J. D. Kopple, D. L. Regidor, J. Jing, C. S. Shinaberger, J. Aronovitz, C. J. McAllister, D. Whellan, and K. Sharma
A1C and Survival in Maintenance Hemodialysis Patients
Diabetes Care,
May 1, 2007;
30(5):
1049 - 1055.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. W. De Keulenaer and D. L. Brutsaert
Systolic and diastolic heart failure: Different phenotypes of the same disease?
Eur J Heart Fail,
February 1, 2007;
9(2):
136 - 143.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Suliman, P. Stenvinkel, A. R. Qureshi, K. Kalantar-Zadeh, P. Barany, O. Heimburger, E. F. Vonesh, and B. Lindholm
The reverse epidemiology of plasma total homocysteine as a mortality risk factor is related to the impact of wasting and inflammation
Nephrol. Dial. Transplant.,
January 1, 2007;
22(1):
209 - 217.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Sandek, M. Lainscak, and W. Doehner
Survival and body fat in hemodialysis patients: true association or effects of concomitant therapy?
Am. J. Clinical Nutrition,
September 1, 2006;
84(3):
663 - 664.
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. van der Harst, A. A. Voors, W. H. van Gilst, M. Bohm, and D. J. van Veldhuisen
Statins in the treatment of chronic heart failure: Biological and clinical considerations
Cardiovasc Res,
August 1, 2006;
71(3):
443 - 454.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
X. Kang, L. J. Shaw, S. W. Hayes, R. Hachamovitch, A. Abidov, I. Cohen, J. D. Friedman, L. E.J. Thomson, D. Polk, G. Germano, et al.
Impact of Body Mass Index on Cardiac Mortality in Patients With Known or Suspected Coronary Artery Disease Undergoing Myocardial Perfusion Single-Photon Emission Computed Tomography
J. Am. Coll. Cardiol.,
April 4, 2006;
47(7):
1418 - 1426.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. N. Simhan and L. M. Bodnar
Prepregnancy Body Mass Index, Vaginal Inflammation, and the Racial Disparity in Preterm Birth
Am. J. Epidemiol.,
March 1, 2006;
163(5):
459 - 466.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. Kalantar-Zadeh, K. C Abbott, and A. K Salahudeen
Reply to S Beddhu et al
Am. J. Clinical Nutrition,
October 1, 2005;
82(4):
910 - 911.
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. Meyer, D. Mortl, K. Strecker, M. Hulsmann, V. Kulemann, T. Neunteufl, R. Pacher, and R. Berger
Flow-Mediated Vasodilation Predicts Outcome in Patients With Chronic Heart Failure: Comparison With B-Type Natriuretic Peptide
J. Am. Coll. Cardiol.,
September 20, 2005;
46(6):
1011 - 1018.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. Kalantar-Zadeh, S. D. Anker, A. J. S. Coats, T. B. Horwich, and G. C. Fonarow
Obesity Paradox as a Component of Reverse Epidemiology in Heart Failure
Arch Intern Med,
August 8, 2005;
165(15):
1797 - 1797.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Escalante, R. W. Haas, and I. del Rincon
Paradoxical Effect of Body Mass Index on Survival in Rheumatoid Arthritis: Role of Comorbidity and Systemic Inflammation
Arch Intern Med,
July 25, 2005;
165(14):
1624 - 1629.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. D Kopple
The phenomenon of altered risk factor patterns or reverse epidemiology in persons with advanced chronic kidney failure
Am. J. Clinical Nutrition,
June 1, 2005;
81(6):
1257 - 1266.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. Kalantar-Zadeh, R. D. Kilpatrick, C. J. McAllister, S. Greenland, and J. D. Kopple
Reverse Epidemiology of Hypertension and Cardiovascular Death in the Hemodialysis Population: The 58th Annual Fall Conference and Scientific Sessions
Hypertension,
April 1, 2005;
45(4):
811 - 817.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
U. Dahlstrom
Frequent non-cardiac comorbidities in patients with chronic heart failure
Eur J Heart Fail,
March 16, 2005;
7(3):
309 - 316.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. Kalantar-Zadeh, K. C Abbott, A. K Salahudeen, R. D Kilpatrick, and T. B Horwich
Survival advantages of obesity in dialysis patients
Am. J. Clinical Nutrition,
March 1, 2005;
81(3):
543 - 554.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. J. Lavie, M. R. Mehra, and R. V. Milani
Obesity and heart failure prognosis: paradox or reverse epidemiology?
Eur. Heart J.,
January 1, 2005;
26(1):
5 - 7.
[Full Text]
[PDF]
|
|
|
|
