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Body composition and prognosis in chronic systolic heart failure: the obesity paradox

      Although obesity has adverse effects on cardiovascular structure and function
      • Messerli F.H.
      Cardiovascular effects of obesity and hypertension.
      ,
      • Lavie C.J.
      • Messerli F.H.
      Cardiovascular adaptation to obesity and hypertension.
      ,
      • Lavie C.J.
      • Ventura H.O.
      • Messerli F.H.
      Left ventricular hypertrophy. Its relationship to obesity and hypertension.
      ,
      • Messerli F.H.
      • Nunez B.D.
      • Ventura H.O.
      • Snyder D.W.
      Overweight and sudden death. Increased ventricular ectopy in cardiopathy of obesity.
      ,
      • Hubert H.B.
      • Feinleib M.
      • McNamara P.M.
      • Castelli W.P.
      Obesity as an independent risk factor for cardiovascular disease a 26-year follow-up of participants in the Framingham Heart Study.
      ,
      • Manson J.E.
      • Colditz G.A.
      • Stampfer M.J.
      • Willett W.C.
      • Rosner B.
      • Monson R.R.
      • Speizer F.E.
      • Hennekens C.H.
      A prospective study of obesity and risk of coronary heart disease in women.
      ,
      • Garavaglia G.E.
      • Messerli F.H.
      • Nunez B.D.
      • Schmieder R.E.
      • Grossman E.
      Myocardial contractility and left ventricular function in obese patients with essential hypertension.
      ,
      • Lavie C.J.
      • Amodeo C.
      • Ventura H.O.
      • Messerli F.H.
      Left atrial abnormalities indicating diastolic ventricular dysfunction in cardiopathy of obesity.
      ,
      • Alpert M.A.
      • Lambert C.R.
      • Panayiotou H.
      • Terry B.E.
      • Cohen M.V.
      • Massey C.V.
      • Hashimi M.W.
      • Mukerji V.
      Relation of duration of morbid obesity to left ventricular mass, systolic function, and diastolic filling, and effect of weight loss.
      ,
      • Alpert M.A.
      • Terry B.E.
      • Mulekar M.
      • Cohen M.V.
      • Massey C.V.
      • Fan T.M.
      • Panayiotou H.
      • Mukerji V.
      Cardiac morphology and left ventricular function in normotensive morbidly obese patients with and without congestive heart failure, and effect of weight loss.
      ,
      • Lavie C.J.
      • Milani R.V.
      Effects of cardiac rehabilitation, exercise training, and weight reduction on exercise capacity, coronary risk factors, behavioral characteristics, and quality of life in obese coronary patients.
      and may be a risk factor for heart failure (HF),
      • Kenchaiah S.
      • Evans J.C.
      • Levy D.
      • Wilson P.W.
      • Benjamin E.J.
      • Larson M.G.
      • Kannel W.B.
      • Vasan R.S.
      Obesity and the risk of heart failure.
      several recent studies have suggested that in patients with chronic systolic HF, obesity is actually associated with trends for better survival.
      • Horwich T.B.
      • Fonarow G.C.
      • Hamilton M.A.
      • MacLellan W.R.
      • Woo M.A.
      • Tillisch J.H.
      The relationship between obesity and mortality in patients with heart failure.
      ,
      • Mosterd A.
      • Cost B.
      • Hoes A.W.
      • de Bruijne M.C.
      • Deckers J.W.
      • Hofman A.
      • Grobbee D.E.
      The prognosis of heart failure in the general population the Rotterdam Study.
      ,
      • Davos C.H.
      • Doehner W.
      • Rauchhaus M.
      • Cicoira M.
      • Francis D.P.
      • Anker S.D.
      Obesity and survival in chronic heart failure.
      However, these studies mostly included patients with severe functional limitations, patients who were in New York Heart Association (NYHA) class IV, and only assessed body mass index (BMI) and not body composition parameters, such as percent body fat. This study examines the impact of obesity and specific various body composition parameters on clinical outcomes in patients with chronic systolic HF and only mild to moderate (NYHA class I to III) functional limitations.
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