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Weight Reduction and Improvements in Endothelial FunctionWeight Loss and Endothelial Function: Combating the “Obesity Paradox” in Coronary Heart Disease

Carl J. Lavie, MD; Richard V. Milani, MD
Author and Funding Information

From the Ochsner Health System.

Correspondence to: Carl J. Lavie, MD, Exercise Laboratories, John Ochsner Heart & Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, 1514 Jefferson Hwy, New Orleans, LA 70121-2483; e-mail: clavie@ochsner.org

Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential 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 (http://www.chestpubs.org/site/misc/reprints.xhtml).


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential 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 (http://www.chestpubs.org/site/misc/reprints.xhtml).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


Chest. 2011;140(6):1395-1396. doi:10.1378/chest.11-1889
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Obesity has adverse effects on almost all cardiovascular (CV) diseases, including coronary heart disease (CHD), where it has been shown to be an independent risk factor.1 Additionally, obesity adversely affects most of the major CHD risk factors, including lipids (leading to hypertriglyceridemia and low levels of high-density lipoprotein cholesterol), hypertension/left ventricular hypertrophy, and glucose abnormalities (metabolic syndrome and diabetes mellitus), and further promotes physical inactivity. Despite the evidence linking obesity to CHD and CHD risk factors, considerable evidence now suggests that among patients with established CV diseases, including CHD, those who are overweight and obese have a better prognosis than do their leaner counterparts, a process that has been termed the “obesity paradox.” Although this paradox is counterintuitive, it has been confirmed by numerous studies and even large meta-analyses.1-4 In general, most studies have assessed overweightness and obesity using BMI criteria, which have significant limitations in assessing true body fatness, since BMI is composed of body fat (BF) and fat-free (eg, muscle) mass. However, we have reported this paradox using both BMI criteria and the more specific percentage of BF criteria.3,4 In fact, we recently reported that low BF, as either a continuous or categorical variable, was an independent predictor of higher mortality in patients with stable CHD.4

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