https://orcid.org/0000-0002-6317-3975
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Jawad H Butt, John J V McMurray, Obesity paradox can be a fact: unveiling the hidden role of adipose tissue, European Heart Journal, Volume 45, Issue 24, 21 June 2024, Page 2168, https://doi.org/10.1093/eurheartj/ehae239
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This commentary refers to ‘Anthropometric measures and adverse outcomes in heart failure with reduced ejection fraction: revisiting the obesity paradox’, by J.H. Butt et al., https://doi.org/10.1093/eurheartj/ehad083 and the discussion piece ‘Obesity paradox can be a fact: unveiling the hidden role of adipose tissue’, by D.-H. Lee, https://doi.org/10.1093/eurheartj/ehae236.
Duk-Hee Lee suggests that because patients with a body mass index of ≥35 kg/m2 (or the highest waist-to-height ratio category) did not exhibit an elevated mortality risk, as might have been expected, there may still be an obesity survival paradox in heart failure. The hypothesis made is that adipose tissue might serve as a store for toxins that would otherwise poison mitochondria, i.e. that adipose tissue has a protective effect. Indeed, it is postulated that the release of these toxins as a consequence of weight loss might be harmful. While intriguing, we know of no clinical data supporting this hypothesis, and, notably, greater obesity was associated with a higher risk of worsening heart failure. The absence of an association with a higher risk of death may simply be a matter of time, with such a consequence not yet apparent during the relatively short follow-up period in the current study.
