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The Importance of the Obesity Paradox in Cardiac Surgery

Carmelo Dominici1 , Giovanni Mariscalco2*, Saverio Nardella1 and Daniele Maselli1

1Department of Cardiovascular Surgery, Cardiac Surgery Unit, S. Anna Hospital Catanzaro, Italy.

2Leicester Cardiovascular Biomedical Research Unit and Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Leicester, UK.

Corresponding Author:
Giovanni Mariscalco
Leicester Cardiovascular Biomedical
Research Unit and Department of Cardiovascular Sciences
University of Leicester, Glenfield Hospital, Leicester, UK
Tel: 4401162583019
E-mail: [email protected]

Received Date: May 20, 2016; Accepted Date: May 23, 2016; Published Date: May 31, 2016

Citation: Dominici C, Mariscalco G, Nardella1 G, Maselli D (2016) The Importance of the “Obesity Paradox” in Cardiac Surgery . Angiol 4:e115. doi:10.4172/2329-9495.1000e115

Copyright: © 2016 Dominici C, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Obesity Paradox in Cardiac Surgery

Obesity is an increasingly chronic health condition, predisposing to coronary artery disease (CAD) and adverse cardiovascular events, having independent effects on hemodynamics and cardiovascular structures, contributing to the derangement of adipose tissue function and inflammatory pathways [1,2]. Obesity promotes endothelial dysfunction favouring atherosclerotic processes, reduces insulin sensitivity, and enhances free fatty acid turnover, thrombogenicity and leptin resistance [3]. In addition, obesity is a cluster of related risk factors including hypertension, diabetes, dyslipidaemia and renal dysfunction, and exacerbating the ongoing cardiovascular disease epidemic [1-3].

Therefore, the reported association between obesity and mortality is not unexpected, despite several studies in both general and disease specific populations have surprisingly reported paradoxical survival benefit in obese patients [4,5]. This inverse relationship between body fat composition and all-cause mortality is commonly labelled as “obesity paradox” [6]. However, prior attempts to firmly demonstrate this paradox and to identify its pathophysiologic mechanisms yielded conflicting results [1-3]. Plausible explanations include increased lean body mass, protective peripheral body fat, reduce inflammatory response, reverse epidemiology, and genetics [4-7].

This should not be certainly taken as an argument to encourage body weight excess, and the ample evidences of the correlation between obesity and death, especially in the long-term period, are indisputable [1,2]. However, why is so important the obesity paradox in cardiac surgery?

In an experimental swine model, high fat diet promoting obesity and renal inflammation prevented post-CPB acute kidney injury [7]. Consonant data have been observed in a high-fat feeding mice model inducing coronary atherosclerosis with related metabolic anaerobic stress changes [8]. During global ischemia, heart with induced coronary disease were markedly resistant to ischemic-reperfusion injury than non-disease heart, suggesting a protective preconditioning metabolic pathway [8]. Similarly, pigs fed a high-fat diet developing hyperlipidaemia in absence of significant weight gain were protected against myocardial ischemic-reperfusion injury [9].

Therefore, the complete understanding of underlying protective mechanisms behind the “obesity paradox” could improve clinical outcomes after cardiac surgery in the early perioperative period.

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Review summary

  1. Eric
    Posted on Aug 02 2016 at 2:25 pm
    The editorial highlights the role of obesity paradox in determining the outcomes and the recovery associated with cardiac surgeries. The author centralises the systemic risks associated with obesity which may pose a threat in the complete recovery of the patient. The article will help in guiding cardiologists to consider the various aspects related to obesity and plan suitable therapeutic strategies for the treatment of cardiac diseases in obese patients.
 

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