Obesity associated with a substantially lower mortality risk in veteran patients without heart failure
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Obesity is paradoxically associated with a decreased risk of adverse outcomes in patients with heart failure, in dialysis patients, and in certain acute coronary states. Such “obesity paradox” was variously ascribed to protection against wasting, to larger coronary arteries and/or to increased muscle mass. Among confounding factors, cardiorespiratory fitness might further affect relative risk estimates associated with obesity, especially in army veterans. A total of 6876 consecutive veteran patients referred for exercise testing were classified by body mass index (BMI) category in three groups, normal weight (18.5 kg/m2< BMI <25 kg/m2), overweight (25 kg/m2< BMI <30 kg/m2) and obesity (BMI ≥30 kg/m2), in order to assess the relation of BMI to mortality. A multivariate analysis including clinical, risk factor and exercise data revealed that higher BMI was associated with better survival, obese patients being 22% less likely to die than normal weight patients (P<0.001). This relationship became stronger after adjusting for cardiorespiratory fitness, obese patients being 35% less likely to die than normal weight patients (P<0.001). In conclusion, adjusting for fitness amplifies the obesity paradox, which, in the studied patient population, may be accounted for by higher cardiorespiratory fitness and obesity in later life.
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