Obesity is a major cardio vascular risk factor.We earnestly believe this by evidence from Framingham and other studies.However , epidemiological truths can be dissociated from individuals .
We now understand some of the obese patients fare better in CHF outcomes apparently because of the obesity ! Even patients who undergo PCI show some benefits.This concept is being proved in large data base of > 200,00 patients.
Possible mechanisms
The lay man’s logic may apply (Science hidden somewhere !) Obese persons have basically a large heart with better cardiac reserve and muscle mass .These hearts are pre-conditioned to extra burden of MVO2 in it’s life time . So it is able to tackle hypoxia better, takes more time to get fully exhausted .After all heart can consume fatty acids for it’s energy requirement.
Adipose tissue may also secrete favorable anti-inflammatory chemicals , though majority of adipocytokines are detrimental except adiponectin .Paradoxically the tumor necrosis factor TNF (Same as cachectin or Interleukin 6) is less in obese patients .
Reference
Reference
The landmark Lancet article that first raised the question of obesity paradox
http://www.ncbi.nlm.nih.gov/pubmed/16920472
http://care.diabetesjournals.org/content/36/Supplement_2/S282.full.pdf+html
Counter to the concept
http://science.howstuffworks.com/life/human-biology/obesity-paradox.htm/printable
Obesity paradox applies in stroke too ! This study (TEMPIS) from Berlin Germany suggest controversially though
Dr.S.Venkatesan MD 