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Obesity: HELP
Articles by Richard V. Milani
Based on 30 articles published since 2008
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Between 2008 and 2019, R. V. Milani wrote the following 30 articles about Obesity.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Editorial Adipose Composition and Heart Failure Prognosis: Paradox or Not? 2017

Lavie, Carl J / Milani, Richard V / Ventura, Hector O. ·Department of Cardiovascular Disease, John Ochsner Heart & Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana. Electronic address: clavie@ochsner.org. · Department of Cardiovascular Disease, John Ochsner Heart & Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana. ·J Am Coll Cardiol · Pubmed #29191322.

ABSTRACT: -- No abstract --

2 Editorial The obesity paradox and obesity severity in elderly STEMI patients. 2017

Lavie, Carl J / Oktay, Ahmet Afsin / Milani, Richard V. ·The John Ochsner Heart & Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA 70121-2483, USA. ·Eur Heart J Qual Care Clin Outcomes · Pubmed #28838098.

ABSTRACT: -- No abstract --

3 Editorial Effects of obesity and weight changes on cardiac and vascular structure and function: does the clinical impact carry any weight? 2014

Lavie, Carl J / Milani, Richard V / Ventura, Hector O. ·Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, Louisiana; Department of Preventive Medicine, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana. Electronic address: clavie@ochsner.org. · Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, Louisiana. ·JACC Heart Fail · Pubmed #25194284.

ABSTRACT: -- No abstract --

4 Editorial Disparate effects of metabolically healthy obesity in coronary heart disease and heart failure. 2014

Lavie, Carl J / Milani, Richard V / Ventura, Hector O. ·Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, Louisiana; Department of Preventive Medicine, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana. Electronic address: clavie@ochsner.org. · Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, Louisiana. ·J Am Coll Cardiol · Pubmed #24345597.

ABSTRACT: -- No abstract --

5 Editorial Does fitness completely explain the obesity paradox? 2013

Lavie, Carl J / De Schutter, Alban / Patel, Dharmendrakumar A / Milani, Richard V. · ·Am Heart J · Pubmed #23816014.

ABSTRACT: -- No abstract --

6 Editorial Body composition and fitness in the obesity paradox--body mass index alone does not tell the whole story. 2013

Lavie, Carl J / De Schutter, Alban / Patel, Dharmendrakumar A / Milani, Richard V. · ·Prev Med · Pubmed #23545240.

ABSTRACT: -- No abstract --

7 Editorial Is there an obesity, overweight, or lean paradox in coronary heart disease? Getting to the 'fat' of the matter. 2013

Lavie, Carl J / De Schutter, Alban / Milani, Richard V. · ·Heart · Pubmed #23470341.

ABSTRACT: -- No abstract --

8 Editorial Impact of obesity on outcomes in myocardial infarction combating the "obesity paradox". 2011

Lavie, Carl J / Milani, Richard V / Ventura, Hector O. · ·J Am Coll Cardiol · Pubmed #22152951.

ABSTRACT: -- No abstract --

9 Editorial Body composition and heart failure prevalence and prognosis: getting to the fat of the matter in the "obesity paradox". 2010

Lavie, Carl J / Milani, Richard V / Ventura, Hector O / Romero-Corral, Abel. · ·Mayo Clin Proc · Pubmed #20592168.

ABSTRACT: -- No abstract --

10 Review An Overview and Update on Obesity and the Obesity Paradox in Cardiovascular Diseases. 2018

Elagizi, Andrew / Kachur, Sergey / Lavie, Carl J / Carbone, Salvatore / Pandey, Ambarish / Ortega, Francisco B / Milani, Richard V. ·Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA, United States of America. · Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA, United States of America. Electronic address: clavie@ochsner.org. · Pauley Heart Center, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, United States of America. · Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America. · Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain. ·Prog Cardiovasc Dis · Pubmed #29981771.

ABSTRACT: Obesity increases a number of cardiovascular disease (CVD) risk factors, but patients with many types of CVD may have a better prognosis if classified as overweight or obese, a phenomenon known as the "obesity paradox". This paradoxical benefit of a medically unfavorable phenotype is particularly strong in the overweight and class I obesity, and less pronounced in the more severe or morbidly obese populations (class II-III and greater). Rather than an obesity paradox, it is possible that this phenomenon may represent a "lean paradox", in which individuals classified as normal weight or underweight may have a poorer prognosis with respect to CVD, as a result of a progressive catabolic state and lean mass loss. Cardiorespiratory fitness (CRF) is a fundamental part of this discussion. A greater CRF is associated with lower CVD risk, regardless of body mass index (BMI). Also, the assessment of body composition compartments (i.e., fat mass, fat-free mass, lean mass) and the presence of metabolic derangements may be better indicators of CVD risk than BMI alone. The focus of this review is to summarize the current evidence of the obesity paradox. Moreover, we discuss the utility and limitations of BMI for cardiometabolic risk stratification, in addition to concepts such as "metabolically healthy obesity" (MHO) and the "fat but fit" phenomenon, which describe patients who are diagnosed with obesity using BMI, but without major metabolic derangements and with greater CRF, respectively. Finally, we propose that obese patients presenting with an excess body fat, yet without metabolic abnormalities, should still be viewed as an "at risk" population, and as such should receive advice to change their lifestyle to improve their CRF and to prevent the development of impaired fasting glucose, diabetes mellitus and other CVD risk factors as a form of primary prevention.

11 Review Obesity and cardiovascular diseases. 2017

Kachur, Sergey / Lavie, Carl J / de Schutter, Alban / Milani, Richard V / Ventura, Hector O. ·Department of Graduate Medical Education, Ocala Regional Medical Center, Ocala, FL, USA - Sergey.kachur@gmail.com. · Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, USA. · New York University School of Medicine, New York, NY, USA. ·Minerva Med · Pubmed #28150485.

ABSTRACT: Obesity is increasingly more common in postindustrial societies, and the burden of childhood obesity is increasing. The major effects of obesity on cardiovascular (CV) health are mediated through the risk of metabolic syndrome (insulin-resistance, dyslipidemia, and hypertension), such that an absence of these risk factors in obese individuals may not be associated with increased mortality risk. In individuals already diagnosed with chronic CV disease (CVD), the overweight and class I obese have significant associations with improved survival. However, this effect is attenuated by increases in cardiorespiratory fitness. The negative effects of obesity on CV health manifest as accelerated progression of atherosclerosis, higher rates of ventricular remodeling and a higher risk of associated diseases, including stroke, myocardial infarction, and heart failure. The most effective therapies at reversing CVD risk factors associated with obesity have been dietary changes with exercise, especially through structured exercise programs, such as cardiac rehabilitation.

12 Review Obesity and Prevalence of Cardiovascular Diseases and Prognosis-The Obesity Paradox Updated. 2016

Lavie, Carl J / De Schutter, Alban / Parto, Parham / Jahangir, Eiman / Kokkinos, Peter / Ortega, Francisco B / Arena, Ross / Milani, Richard V. ·Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, LA, USA. Electronic address: clavie@ochsner.org. · Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, LA, USA. · Veterans Affairs Medical Center, Cardiology Department, Georgetown University School of Medicine, Washington, DC, USA. · PROFITH "PROmoting FITness and Health through Physical Activity" Research Group, Department of Physical Education and Sports, Faculty of Sports Sciences, University of Granada, Granada, Spain. · Department of Physical Therapy, Department of Kinesiology and Nutrition, Integrative Physiology Laboratory, College of Applied Science, University of Illinois at Chicago, Chicago, IL, USA. ·Prog Cardiovasc Dis · Pubmed #26826295.

ABSTRACT: The prevalence and severity of obesity have increased in the United States and most of the Westernized World over recent decades, reaching worldwide epidemics. Since obesity worsens most of the cardiovascular disease (CVD) risk factors, not surprisingly, most CVDs, including hypertension, coronary heart disease, heart failure, and atrial fibrillation, are all increased in the setting of obesity. However, many studies and meta-analyses have demonstrated an obesity paradox with regards to prognosis in CVD patients, with often the overweight and mildly obese having a better prognosis than do their leaner counterparts with the same CVD. The implication for fitness to markedly alter the relationship between adiposity and prognosis and the potential impact of weight loss, in light of the obesity paradox, are all reviewed.

13 Review Update on Obesity and Obesity Paradox in Heart Failure. 2016

Lavie, Carl J / Sharma, Abhishek / Alpert, Martin A / De Schutter, Alban / Lopez-Jimenez, Francisco / Milani, Richard V / Ventura, Hector O. ·Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, LA. Electronic address: clavie@ochsner.org. · Division of Cardiovascular Medicine, State University of New York Downstate Medical Center, New York, NY. · Division of Cardiovascular Medicine, University Missouri School of Medicine, Columbia, MO. · Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, LA. · Division of Cardiology, Mayo College of Medicine, Rochester, MN. ·Prog Cardiovasc Dis · Pubmed #26721180.

ABSTRACT: Obesity has reached epidemic proportions in most of the Westernized world. Overweightness and obesity adversely impact cardiac structure and function, including on both the right and, especially, left sides of the heart, with adverse affects on systolic and, especially, diastolic ventricular function. Therefore, it is not surprising that obesity markedly increases the prevalence of heart failure (HF). Nevertheless, many studies have documented an obesity paradox in large cohorts with HF, where overweight and obese have a better prognosis, at least in the short-term, compared with lean HF patients. Although weight loss clearly improves cardiac structure and function and reduces symptoms in HF, there are no large studies on the impact of weight loss on clinical events in HF, preventing definitive guidelines on optimal body composition in patients with HF.

14 Review Exercise and the cardiovascular system: clinical science and cardiovascular outcomes. 2015

Lavie, Carl J / Arena, Ross / Swift, Damon L / Johannsen, Neil M / Sui, Xuemei / Lee, Duck-Chul / Earnest, Conrad P / Church, Timothy S / O'Keefe, James H / Milani, Richard V / Blair, Steven N. ·From the Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, LA (C.J.L., R.V.M.) · Department of Physical Therapy and Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago (R.A.) · Department of Kinesiology, East Carolina University, Greenville, NC (D.L.S.) · Department of Preventive Medicine, Pennington Biomedical Research Center, Baton Rouge, LA (N.M.J., T.S.C.) · School of Kinesiology, Louisiana State University, Baton Rouge (N.M.J.) · Department of Exercise Science, Arnold School of Public Health University of South Carolina, Columbia (X.S., S.N.B.) · Department of Kinesiology, College of Human Sciences, Iowa State University, Ames (D.c.L.) · Department of Health and Kinesiology, Texas A&M University, College Station (C.P.E.) · and Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (J.H.O.). ·Circ Res · Pubmed #26139859.

ABSTRACT: Substantial evidence has established the value of high levels of physical activity, exercise training (ET), and overall cardiorespiratory fitness in the prevention and treatment of cardiovascular diseases. This article reviews some basics of exercise physiology and the acute and chronic responses of ET, as well as the effect of physical activity and cardiorespiratory fitness on cardiovascular diseases. This review also surveys data from epidemiological and ET studies in the primary and secondary prevention of cardiovascular diseases, particularly coronary heart disease and heart failure. These data strongly support the routine prescription of ET to all patients and referrals for patients with cardiovascular diseases, especially coronary heart disease and heart failure, to specific cardiac rehabilitation and ET programs.

15 Review Healthy obese versus unhealthy lean: the obesity paradox. 2015

Lavie, Carl J / De Schutter, Alban / Milani, Richard V. ·Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA 70121-2483, USA. ·Nat Rev Endocrinol · Pubmed #25265977.

ABSTRACT: Overweight and obesity have reached epidemic proportions in the USA and most of the rest of the world. Particularly concerning is the very high prevalence of class III obesity (BMI ≥40 kg/m(2)), which has reached ∼3% in the USA. In the past few years, controversy has surrounded the idea that some individuals with obesity can be considered healthy with regards to their metabolic and cardiorespiratory fitness, which has been termed the 'obesity paradox'. These controversies are reviewed in detail here, including discussion of the very favourable prognosis in patients with obesity who have no notable metabolic abnormalities and who have preserved fitness. The article also discusses the suggestion that greater emphasis should be placed on improving fitness rather than weight loss per se in the primary and secondary prevention of cardiovascular diseases, at least in patients with overweight and class I obesity (BMI 30-35 kg/m(2)).

16 Review Obesity paradox, cachexia, frailty, and heart failure. 2014

Lavie, Carl J / De Schutter, Alban / Alpert, Martin A / Mehra, Mandeep R / Milani, Richard V / Ventura, Hector O. ·Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA 70121-2483, USA; Cardiac Rehabilitation, Exercise Laboratories, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA 70121-2483, USA; Department of Preventive Medicine, Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA 70808, USA. Electronic address: clavie@ochsner.org. · Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA 70121-2483, USA. · Division of Cardiovascular Medicine, University of Missouri School of Medicine, Room CE-338, 5 Hospital Drive, Columbia, MO 65202, USA. · BWH Heart and Vascular Center and Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, A Building, 3rd Floor, Room AB324, Boston, MA 02115, USA. ·Heart Fail Clin · Pubmed #24656108.

ABSTRACT: Overweight and obesity adversely affect cardiovascular (CV) risk factors and CV structure and function, and lead to a marked increase in the risk of developing heart failure (HF). Despite this, an obesity paradox exists, wherein those who are overweight and obese with HF have a better prognosis than their leaner counterparts, and the underweight, frail, and cachectic have a particularly poor prognosis. In light of this, the potential benefits of exercise training and efforts to improve cardiorespiratory fitness, as well as the potential for weight reduction, especially in severely obese patients with HF, are discussed.

17 Review Obesity and cardiovascular diseases: implications regarding fitness, fatness, and severity in the obesity paradox. 2014

Lavie, Carl J / McAuley, Paul A / Church, Timothy S / Milani, Richard V / Blair, Steven N. ·Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, Louisiana; Department of Preventive Medicine, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana. Electronic address: clavie@ochsner.org. · Department of Human Performance and Sport Sciences, Winston-Salem State University, Winston-Salem, North Carolina. · Department of Preventive Medicine, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana. · Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, Louisiana. · Department of Exercise Science and Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina. ·J Am Coll Cardiol · Pubmed #24530666.

ABSTRACT: Obesity has been increasing in epidemic proportions, with a disproportionately higher increase in morbid or class III obesity, and obesity adversely affects cardiovascular (CV) hemodynamics, structure, and function, as well as increases the prevalence of most CV diseases. Progressive declines in physical activity over 5 decades have occurred and have primarily caused the obesity epidemic. Despite the potential adverse impact of overweight and obesity, recent epidemiological data have demonstrated an association of mild obesity and, particularly, overweight on improved survival. We review in detail the obesity paradox in CV diseases where overweight and at least mildly obese patients with most CV diseases seem to have a better prognosis than do their leaner counterparts. The implications of cardiorespiratory fitness with prognosis are discussed, along with the joint impact of fitness and adiposity on the obesity paradox. Finally, in light of the obesity paradox, the potential value of purposeful weight loss and increased physical activity to affect levels of fitness is reviewed.

18 Review The impact of obesity on risk factors and prevalence and prognosis of coronary heart disease-the obesity paradox. 2014

De Schutter, Alban / Lavie, Carl J / Milani, Richard V. ·Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, LA. · Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, LA; The Department of Preventive Medicine, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA. Electronic address: clavie@ochsner.org. ·Prog Cardiovasc Dis · Pubmed #24438731.

ABSTRACT: Obesity is associated with a host of cardiovascular risk factors and its prevalence is rising rapidly. Despite strong evidence that obesity predisposes to the development and progression of coronary heart disease (CHD), numerous studies have shown an inverse relationship between various measures of obesity (most commonly body mass index) and outcomes in established CHD. In this article we review the evidence surrounding the ≪obesity paradox≫ in the secondary care of CHD patients and the CHD presentations where a paradox has been found. Finally we discuss the impact of cardiorespiratory fitness and a number of mechanisms which may offer potential explanations for this puzzling phenomenon.

19 Review Impact of obesity and the obesity paradox on prevalence and prognosis in heart failure. 2013

Lavie, Carl J / Alpert, Martin A / Arena, Ross / Mehra, Mandeep R / Milani, Richard V / Ventura, Hector O. ·Department of Cardiovascular Diseases, John Ochsner Heart & Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, Louisiana; Department of Preventive Medicine, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana. Electronic address: clavie@ochsner.org. · Division of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, Missouri. · Division of Physical Therapy, Department of Orthopaedics and Rehabilitation and Division of Cardiology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico. · Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. · Department of Cardiovascular Diseases, John Ochsner Heart & Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, Louisiana. ·JACC Heart Fail · Pubmed #24621833.

ABSTRACT: Obesity has reached epidemic proportions in the United States and worldwide. Considering the adverse effects of obesity on left ventricular (LV) structure, diastolic and systolic function, and other risk factors for heart failure (HF), including hypertension and coronary heart disease, HF incidence and prevalence, not surprisingly, is markedly increased in obese patients. Nevertheless, as with most other cardiovascular diseases, numerous studies have documented an obesity paradox, in which overweight and obese patients, defined by body mass index, percent body fat, or central obesity, demonstrate a better prognosis compared with lean or underweight HF patients. This review will describe the data on obesity in the context of cardiopulmonary exercise testing in HF. Additionally, the implications of obesity on LV assist devices and heart transplantation are reviewed. Finally, despite the obesity paradox, we address the current state of weight reduction in HF.

20 Review Cardiometabolic risk factors and atrial fibrillation. 2013

Menezes, Arthur R / Lavie, Carl J / Dinicolantonio, James J / O'Keefe, James / Morin, Daniel P / Khatib, Sammy / Abi-Samra, Freddy M / Messerli, Franz H / Milani, Richard V. ·Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA. · Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA; Department of Preventative Cardiology, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA. · Wegmans Pharmacy, Ithaca, NY. · St. Luke's Mid America Heart Institute, Kansas City, MO. · St. Luke's-Roosevelt Hospital Center, New York, NY. ·Rev Cardiovasc Med · Pubmed #24448257.

ABSTRACT: Atrial fibrillation (AF) is the most common arrhythmia worldwide; it is a significant risk factor for stroke and embolization, and has an impact on cardiac function. Despite its impact on morbidity and mortality, our understanding of the etiology and pathophysiology of this disease process is still incomplete. Over the past several decades, there has been evidence to suggest that AF has a significant correlation with metabolic syndrome (MetS). Furthermore, AF appears to be more closely related to specific components of MetS compared with others. This article provides an overview of the various components of MetS and their impact on AF.

21 Review Obesity paradox and the heart: which indicator of obesity best describes this complex relationship? 2013

De Schutter, Alban / Lavie, Carl J / Patel, Dharmendrakumar A / Milani, Richard V. ·Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, Louisiana, USA. ·Curr Opin Clin Nutr Metab Care · Pubmed #23892506.

ABSTRACT: PURPOSE OF REVIEW: Despite the detrimental effects of obesity on coronary heart disease (CHD) and heart failure, obesity is found to be paradoxically associated with improved survival in secondary care of CHD and heart failure. This 'obesity paradox' is an area of active research, and it might be the result of an inaccurate working definition of obesity, which is traditionally defined in terms of BMI. We reviewed the recent literature on the paradox and examined different anthropomorphic measurements and their association with prognosis in cardiovascular diseases. RECENT FINDINGS: In CHD, obesity is associated with improved prognosis when defined by high BMI and body fat, independent of fat-free mass (FFM). High waist circumference seems to be associated with worse prognosis in some studies, but is associated with protection and an obesity paradox in those with poor cardiorespiratory fitness (CRF). In patients with heart failure, BMI, body fat and waist circumference, and possibly FFM, have been associated with improved survival. Despite these findings, intentional weight loss remains protective. In both CHD and heart failure, CRF seems to significantly impact the relationship between adiposity and subsequent prognosis, and an obesity paradox is only present with low CRF. SUMMARY: Body composition, including waist circumference, body fat and FFM have a role in clinical practice. Emphasis should be placed on improving CRF, regardless of weight status. Intentional weight loss, particularly while maintaining FFM, should be encouraged in obese individuals.

22 Clinical Trial Relation of body fat categories by Gallagher classification and by continuous variables to mortality in patients with coronary heart disease. 2013

De Schutter, Alban / Lavie, Carl J / Patel, Dharmendrakumar A / Artham, Surya M / Milani, Richard V. ·John Ochsner Heart & Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA. ·Am J Cardiol · Pubmed #23261004.

ABSTRACT: Although obesity is a coronary heart disease risk factor, in cohorts of patients with coronary heart disease, an "obesity paradox" exists whereby patients with obesity have a better prognosis than do leaner patients. Obesity is generally defined by body mass index, with relatively little described regarding body fat (BF). In this study, 581 consecutive patients with coronary heart disease divided into the Gallagher BF categories of underweight (n = 12), normal (n = 189), overweight (n = 214), and obese (n = 166) were evaluated, and 3-year mortality was assessed using the National Death Index. Mortality was U shaped, being highest in the underweight group (25%, p <0.0001 vs all groups) and lowest in the overweight group (2.3%), with intermediate mortality in the normal-BF (6.4%, p = 0.02 vs overweight) and obese (3.6%) groups. In multiple regression analysis, high BF (odds ratio 0.89, 95% confidence interval 0.82 to 0.95) and higher Gallagher class (odds ratio 0.46, 95% confidence interval 0.25 to 0.84) were independent predictors of lower mortality. In conclusion, on the basis of Gallagher BF, an obesity paradox exists, with the highest mortality in the underweight and normal-BF groups and the lowest mortality in the overweight group. Lower BF as a continuous variable and by Gallagher classification as a categorical value were independent predictors of higher mortality.

23 Article The impact of inflammation on the obesity paradox in coronary heart disease. 2016

De Schutter, A / Kachur, S / Lavie, C J / Boddepalli, R S / Patel, D A / Milani, R V. ·John Ochsner Heart and Vascular Institute, Ochsner Clinical School - The University of Queensland School of Medicine, New Orleans, LA, USA. · Department of Medicine, Cleveland Clinic Florida, Weston, FL, USA. · Ocala Regional Medical Center, Ocala, FL, USA. · Division of Cardiovascular Medicine, UT Erlanger Cardiology - Erlanger Health System and University of Tennessee, College of Medicine, Chattanooga, TN, USA. ·Int J Obes (Lond) · Pubmed #27453423.

ABSTRACT: BACKGROUND: Despite the well-known adverse effects of obesity on almost all aspects of coronary heart disease, many studies of coronary heart disease cohorts have demonstrated an inverse relationship between obesity, as defined by body mass index (BMI), and subsequent prognosis: the 'obesity paradox'. The etiology of this and the potential role of inflammation in this process remain unknown. PATIENTS AND METHODS: We studied 519 patients with coronary heart disease before and after cardiac rehabilitation, dividing them into groups based on C-reactive protein ((CRP)⩾3 mg l RESULTS: During >3-year follow-up, all-cause mortality was higher in the high inflammation and in the low BMI group. In proportional hazard analysis, even after adjusting for ejection fraction and peak O CONCLUSIONS: The obesity paradox has multiple underlying etiologies. Body composition has a different role in different populations with an obesity paradox by BMI. Especially in the subpopulation with persistently high CRP levels, body fat seems protective.

24 Article Body composition and mortality in a large cohort with preserved ejection fraction: untangling the obesity paradox. 2014

De Schutter, Alban / Lavie, Carl J / Kachur, Sergey / Patel, Dharmendrakumar A / Milani, Richard V. ·John Ochsner Heart & Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA; Department of Medicine, Cleveland Clinic Florida, Weston. · John Ochsner Heart & Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA; Department of Preventive Medicine, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge. Electronic address: clavie@ochsner.org. · Department of Medicine, Cleveland Clinic Florida, Weston. · John Ochsner Heart & Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA. ·Mayo Clin Proc · Pubmed #25039037.

ABSTRACT: OBJECTIVE: To evaluate the effects of body composition as a function of lean mass index (LMI) and body fat (BF) on the correlation between increasing body mass index (BMI; calculated as the weight in kilograms divided by the height in meters squared) and decreasing mortality, which is known as the obesity paradox. PATIENTS AND METHODS: We retrospectively assessed 47,866 patients with preserved left ventricular ejection fraction (≥50%). We calculated BF by using the Jackson-Pollock equation and LMI using (1 - BF) × BMI. The population was divided according to the sex-adjusted BMI classification, sex-adjusted LMI classification, and sex-adjusted BF tertiles. The population was analyzed by using multivariate analysis for total mortality over a mean follow-up duration of 3.1 years by using the National Death Index, adjusting for left ventricular ejection fraction, left ventricular mass index, age, sex, and relative wall thickness. RESULTS: In the entire population, higher BMI was narrowly associated (hazard ratio [HR], 0.99; P<.001) with lower mortality. The higher LMI group was clearly protective (HR, 0.71; P<.001), whereas BF tertile was associated with lower mortality only if no adjustment was made for LMI (HR, 0.87; P<.001 without LMI; HR, 0.97; P=.23 with LMI). In the lean patients, low BMI was clearly associated with higher mortality (HR, 0.92; P<.001) and lower BF tertile was associated with lower mortality only if no adjustment was made for LMI (HR, 0.80; P<.001 without LMI; HR, 1.01; P=.83 with LMI). The underweight patients stratified by BF seemed to have an increased mortality (HR, 1.91; 95% CI, 1.56-2.34) that was independent of LMI. However, in obese patients, both BMI (HR, 1.03; P<.001) and BF (HR, 1.18; P=.003) were associated with higher mortality, even after adjusting for LMI, which remained protective (HR, 0.57; P<.001) independently of BF. CONCLUSION: Body composition could explain the inverse J shape of the mortality curve noted with increasing BMI. Body fat seems to be protective in this cohort only if no adjustment was made for LMI, although being underweight stratified by BF seems to be an independent risk factor. Lean mass index seems to remain protective in obese patients even when BMI is not.

25 Article Effects of left ventricular geometry and obesity on mortality in women with normal ejection fraction. 2014

Patel, Dharmendrakumar A / Lavie, Carl J / Artham, Surya M / Milani, Richard V / Cardenas, Gustavo A / Ventura, Hector O. ·UT Erlanger Cardiology, Erlanger Health System, Chattanooga, Tennessee. · Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana; Department of Preventive Medicine, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana. Electronic address: clavie@ochsner.org. · Sanford Cardiology, Bismarck, North Dakota. · Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana. · Palm Beach Heart Associates and University of Miami-Miller School of Medicine, Atlantis, Florida. ·Am J Cardiol · Pubmed #24406112.

ABSTRACT: Left ventricular (LV) geometry is an independent predictor of cardiovascular morbidity and mortality. Although obesity is a known risk factor for cardiovascular diseases, studies have suggested a paradoxical relation between obesity and prognosis. We retrospectively assessed 26,126 female patients with normal LV ejection fraction to determine the impact of LV geometry, including normal structure, concentric remodeling, and eccentric or concentric LV hypertrophy, and obesity on mortality during an average follow-up of 1.7 years. Abnormal LV geometry occurred more commonly in obese (body mass index ≥30 kg/m(2), n = 10,465) compared with nonobese (body mass index <30 kg/m(2), n = 15,661) patients (56% vs 47%, respectively, p <0.0001). Overall mortality, however, was considerably less in obese compared with nonobese patients (5.6% vs 8.7%, respectively, p <0.0001). In both groups, progressive increases in mortality were observed from normal structure to concentric remodeling and then to eccentric and concentric LV hypertrophy (obese patients 2.9%, 6.5%, 6.7%, and 11.1%, respectively, and nonobese patients 5.3%, 10.6%, 11.4%, and 16.8%, respectively, p <0.0001 for trend). In conclusion, although an obesity paradox exists, in that obesity in women is associated with abnormal LV geometry but less mortality, our data demonstrate that abnormal LV geometric patterns are highly prevalent in both obese and nonobese female patients with normal ejection fraction and are associated with greater mortality.

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