LETTER TO THE EDITOR
Is the hippocrates paradox really a paradox?
Tsung O. Cheng, MD, FACC
Professor of Medicine, George Washington University, Medical Center, 2150 Pennsylvania Ave., NW, Washington, DC 20037, USA
tcheng{at}mfa.gwu.edu
In the Editorial Comment by Lavie and Milani (1) accompanying the report by Reeves and associates (2), the correspondents used as their title "Obesity and Cardiovascular Disease: The Hippocrates Paradox?". Lavie and Milani began their comment by quoting a statement by Hippocrates, namely, "Sudden death is more common in those who are naturally fat than in the lean." Clearly Hippocrates recognized the association between obesity and cardiovascular disease. According to the American Heritage Dictionary of the English Language, paradox is "a seemingly contradictory statement that may nonetheless be true" (3). Because Hippocrates recognized the association between obesity and sudden cardiac death, his quoted statement is therefore not a paradox.
The use by Lavie and Milani (1) of the word "paradox" is reminiscent of the description of "pulsus paradoxus" in cardiac tamponade. As Spodick stated so succinctly in his book (4), "Pulsus paradoxus, as Kussmaul described it, was a change in a pulse (pulsus), not a pressure. Indeed, he had no blood pressure cuff or catheter, and it was ‘paradoxic’ to him, since the radial pulse disappeared intermittently (during inspiration) while the heart continued to beat without interruption. Pulsus paradoxus is an exaggeration of the normal phenomenon of an inspiratory fall in systolic arterial pressure."
Perhaps, Lavie and Milani had in mind the same phenomenon of an exaggeration when they coined the term "the Hippocrates paradox" because Hippocrates not only associated obesity with cardiovascular disease, but went further to associate obesity with sudden death due to cardiovascular disease. Hippocrates also condemned overeating: "Repletion, carried to extremes, is perilous" (Aphorisms 1), and he warned against exercise after eating: "Fat people who want to reduce should take their exercise on an empty stomach" (5). Furthermore, Hippocrates observed that obesity also predisposed to cerebrovascular disease and that the slender person is likely to outlive his heavier neighbor (6).
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References
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- Lavie CJ, Milani RV. Obesity and cardiovascular disease: the Hippocrates paradox? J Am Coll Cardiol. 2003;42:677–679[Free Full Text]
- Reeves BC, Ascione R, Chamberlain MH, Angelini GD. Effect of body mass index on early outcomes in patients undergoing coronary artery bypass surgery. J Am Coll Cardiol. 2003;42:668–676[Abstract/Free Full Text]
- The American Heritage Dictionary of the English Language. 4th ed. Boston, MA: Houghton Mifflin, 2000
- Spodick D. The Pericardium. New York, NY: Marcel Dekker; 1997. p. 191
- Cheng TO. Hippocrates and cardiology. Am Heart J. 2001;141:173–183[Medline]
- Katz AM, Katz PB. Diseases of the heart in the works of Hippocrates. Br Heart J. 1962;24:257–264[Abstract/Free Full Text]
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