Doehner Wolfram
Centre for Stroke Research Berlin and Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany,
Heart Fail Rev. 2014 Sep;19(5):637-44. doi: 10.1007/s10741-014-9425-z.
Overweight has been shown in multiple studies to carry a survival benefit in heart failure (HF) patients. This finding is, of course, counterintuitive to the well-established role of obesity as a modifiable risk factor for incident cardiovascular disease. The debate on the relevance of this obesity paradox is on-going, and clinical, methodological and teleological aspects are discussed. Particularly, younger age and a seemingly favourable clinical status of obese patients are repeatedly discussed together with the lack of prospective data to question the validity of the observed survival advantage in obese HF patients. Recent risk score calculators, however, have included body weight as an inverse risk factor, i.e. higher body mass index is predicting better outcome. Emerging prospective interventional trials support the concept that in patients with established disease, intentional weight reduction may not necessarily translate into improved outcome. The clinically most relevant consequence from the emerging data is, of course, the practical recommendation on body weight management that we may give our (overweight) patients. While the terminology as a paradox is critically discussed, a more differentiated concept for weight management should be emphasized that distinguishes between healthy subjects and those with an established cardiovascular disease such as heart failure.
多项研究表明，超重对心力衰竭（HF）患者具有生存益处。当然，这一发现与肥胖作为心血管疾病可改变风险因素的既定作用相悖。关于这一肥胖悖论相关性的争论仍在继续，人们讨论了临床、方法学和目的论等方面。特别是，肥胖患者较年轻的年龄和看似良好的临床状态经常被提及，同时缺乏前瞻性数据来质疑肥胖HF患者生存优势的有效性。然而，最近的风险评分计算器已将体重作为反向风险因素，即较高的体重指数预示着更好的结果。新出现的前瞻性干预试验支持这样一种观点，即在已确诊疾病的患者中，有意减轻体重不一定能转化为更好的结果。新出现的数据在临床上最相关的结果当然是我们可能给予（超重）患者的关于体重管理的实际建议。虽然对悖论这一术语进行了批判性讨论，但应强调一种更具区分性的体重管理概念，即区分健康受试者和患有如心力衰竭等既定心血管疾病的患者。
