What is referred to as the "obesity paradox" in heart failure?

The "obesity paradox" in heart failure refers to the phenomenon where higher body mass index (BMI) is associated with longer survival rates among patients with heart failure, contrary to the expected relationship between obesity and poorer health outcomes. Research has indicated that, in certain populations of heart failure patients, those who are overweight or mildly obese may actually experience better survival rates compared to those with a normal weight or underweight.

This paradox may occur for several reasons. Individuals with a higher BMI may have more metabolic reserve or better nutritional status, which could help them withstand the stress of heart failure. Additionally, those who are larger may present with different clinical profiles or have protective factors that mitigate the severity of heart failure symptoms.

While the specific reasons for this paradox are still under investigation, the overall finding that a higher BMI correlates with extended survival in heart failure patients has led to discussions around the complexities of obesity and its impacts on health outcomes. This contrasts with other health conditions where obesity is consistently associated with worse outcomes.