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Tankó and Christiansen propose that the obesity paradox in patients with heart failure may be in part mediated by increased production of adiponectin in obese heart failure patients with excess peripheral fat. The Digitalis Investigation Group Trial did not obtain information regarding hip and waist circumference, and thus we are unable to determine whether a pattern of peripheral obesity contributes to the improved outcomes observed in overweight and obese patients. We found no evidence, however, that the association of improved outcomes in heart failure patients with excess weight varies by sex. Although women in each BMI category had a lower risk of mortality compared with men, the absolute difference in mortality between patients in the lowest and highest BMI categories were comparable (men, 19.1% difference; women, 16.7% difference) (Table 4 of the original publication).^1(p59)

Kalantar-Zadeh and colleagues point out that "paradoxical" associations between accepted risk factors and outcomes . . . [Full Text of this Article]

AUTHOR INFORMATION
Jeptha P. Curtis, MD; Yongfei Wang, MS; Harlan M. Krumholz, MD, SM