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Editorials |

The “Obesity Paradox”: Is Smoking/Lung Disease the Explanation?

Carl J. Lavie, MD, FCCP; Hector O. Ventura, MD; Richard V. Milani, MD
Author and Funding Information

Correspondence to: Carl J. Lavie, MD, FCCP, Medical Director, Cardiac Rehabilitation and Prevention, Director, Exercise Laboratories, Ochsner Medical Center, 1514 Jefferson Hwy, New Orleans, LA 70121-2483; e-mail: clavie@ochsner.org

Dr. Lavie is Medical Director, Cardiac Rehabilitation and Prevention, Director, Exercise Laboratories, Ochsner Medical Center.

Dr. Ventura is Chairman of Graduate Medical Education, and Director of Advanced Heart Failure and Transplantation, Ochsner Medical Center.

Dr. Milani is Vice Chairman, Department of Cardiovascular Diseases, Ochsner Medical Center.


The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2008;134(5):896-898. doi:10.1378/chest.08-1673
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Many studies indicate that overweight and obesity are extremely prevalent in Westernized societies, and during recent decades, the prevalence has been markedly increasing, especially in the United States.1 If current trends continue, obesity will soon overtake cigarette smoking as the leading cause of preventable death in the United States.1 Substantial evidence documents the “heavy” cardiovascular (CV) burden of obesity. Overweight/obesity is a strong risk factor for the development and progression of hypertension, dyslipidemia (especially elevated triglycerides and low levels of high-density lipoprotein cholesterol), metabolic syndrome, and type 2 diabetes mellitus, and increases systemic inflammation (eg, high levels of C-reactive protein).13 Although hypertension is a strong risk factor for left ventricular hypertrophy, obesity contributes to left ventricular hypertrophy and other ventricular structural abnormalities independent of arterial pressure.1,2 Although all of these factors contribute to atherosclerosis and coronary heart disease (CHD), obesity is probably an independent risk factor.13 Additionally, obesity has adverse affects on both systolic and diastolic ventricular function, and is associated with an increased risk of heart failure (HF).1,4 Therefore, the prevention and treatment of overweight/obesity are major societal concerns.

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