Is there an ‘obesity paradox’ of cardiac survival in heart disease ? A perspective from experimental laboratory studies

Abdominal obesity is associated with the development of cardiovascular disease. However, an ‘obesity paradox’ phenomenon has been identified whereby cardiovascular events that may ultimately lead to heart failure, in a setting of obesity occur with relatively lower severity affording the obese patient a greater chance of survival. The obesity paradox has partly been explained by a higher substrate availability to augmented muscle and fat masses, thus permitting greater resistance to injury and capacity for adaptive remodelling and survival. However, recent research advances show that substrate utilization is probably not the only parameter contributing to the obesity paradox. This book summarizes laboratory data showing that obesity triggers molecular changes at the cardiac level which can partly explain the obesity paradox.