Is the Hippocrates paradox really a paradox?

n the Editorial Comment by Lavie and Milani (1) accompanying he report by Reeves and associates (2), the correspondents used as heir title “Obesity and Cardiovascular Disease: The Hippocrates aradox?”. Lavie and Milani began their comment by quoting a tatement by Hippocrates, namely, “Sudden death is more comon in those who are naturally fat than in the lean.” Clearly ippocrates recognized the association between obesity and cariovascular disease. According to the American Heritage Dictionary f the English Language, paradox is “a seemingly contradictory tatement that may nonetheless be true” (3). Because Hippocrates ecognized the association between obesity and sudden cardiac eath, his quoted statement is therefore not a paradox. The use by Lavie and Milani (1) of the word “paradox” is eminiscent of the description of “pulsus paradoxus” in cardiac amponade. As Spodick stated so succinctly in his book (4), Pulsus paradoxus, as Kussmaul described it, was a change in a ulse (pulsus), not a pressure. Indeed, he had no blood pressure cuff r catheter, and it was ‘paradoxic’ to him, since the radial pulse isappeared intermittently (during inspiration) while the heart ontinued to beat without interruption. Pulsus paradoxus is an xaggeration of the normal phenomenon of an inspiratory fall in ystolic arterial pressure.” Perhaps, Lavie and Milani had in mind the same phenomenon f an exaggeration when they coined the term “the Hippocrates aradox” because Hippocrates not only associated obesity with ardiovascular disease, but went further to associate obesity with udden death due to cardiovascular disease. Hippocrates also ondemned overeating: “Repletion, carried to extremes, is perilous” Aphorisms 1), and he warned against exercise after eating: “Fat eople who want to reduce should take their exercise on an empty tomach” (5). Furthermore, Hippocrates observed that obesity also redisposed to cerebrovascular disease and that the slender person s likely to outlive his heavier neighbor (6).