Das Adipositas-Paradox

Eine Vielzahl von großen epidemiologischen Studien belegt die Tatsache, dass Übergewicht und Adipositas mit einer gesteigerten Gesamt-Mortalität, einer gesteigerten kardiovaskulären Mortalität sowie mit einer erhöhten Krebsrate einhergehen. Diese Untersuchungen wurden überwiegend an – bei Eintritt in die Studie – gesunden Probanden durchgeführt. Verfolgt man jedoch Patienten nach durchgemachtem Herzinfarkt oder Patienten mit der Diagnose einer chronischen Herzinsuffizienz, so haben Patienten mit Übergewicht oder Adipositas eine bessere Prognose. Dieses sogenannte Adipositas-Paradox wird in mehreren Beobachtungsstudien beschrieben. Die vorliegende Arbeit behandelt Erklärungsmodelle für dieses Phänomen und gibt auf dieser Basis Vorschläge zur Behandlung adipöser Herzpatienten.

A number of epidemiologic studies including up to one million participants have clearly demonstrated that obesity and overweight go hand in hand with an increased rate of total mortality, cardiovascular mortality as well as tumor mortality. These studies were conducted in the general population, i.e., participants had not known cardiovascular disease at study entry.

However, when patients were followed up after having suffered from a heart attack (myocardial infarction or unstable angina) or with diagnosed chronic heart failure, overweight or obese patients have a better prognosis than those with normal or lower weight. This so-called obesity-paradox has been described in a number of observational studies.

The present study discusses potential models to explain this paradoxical phenomenon, and suggests on this basis some treatment options for overweight and obese cardiac patients.

Key words

Obesity - obesity-paradox - overweight - normal weight - prognosis - cardiovascular disease - mortality

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