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Risk factor paradox in wasting diseases.

Kamyar Kalantar-Zadeh¹, Tamara B Horwich, Antigone Oreopoulos

¹Harold Simmons Center for Kidney Disease Research and Epidemiology, Los Angeles Biomedical Research Center at Harbor-UCLA, Torrance, California 90509-2910, USA. kamkal@ucla.edu

Current Opinion in Clinical Nutrition and Metabolic Care

|June 15, 2007

Summary

Conventional cardiovascular risk factors like obesity are paradoxically linked to better survival in wasting conditions. This "reverse epidemiology" challenges traditional risk assessment in chronic diseases.

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Area of Science:

Cardiovascular disease
Metabolic disorders
Gerontology

Background:

Conventional cardiovascular risk factors (e.g., hypercholesterolemia, obesity) show paradoxical associations with survival in specific wasting populations.
This phenomenon, termed

Purpose of the Study:

Identify populations exhibiting the cardiovascular risk factor survival paradox.
Review the survival paradoxes and underlying pathophysiologic mechanisms in these groups.
Explore implications for clinical medicine and public health strategies.

Main Methods:

Literature review of studies on cardiovascular risk factors and survival in wasting conditions.
Analysis of populations with chronic kidney disease, heart failure, COPD, cancer, AIDS, rheumatoid arthritis, and the elderly.
Synthesis of proposed pathophysiologic mechanisms contributing to the paradox.

Main Results:

A "reverse epidemiology" of cardiovascular risk is observed in chronic kidney disease, heart failure, COPD, cancer, AIDS, rheumatoid arthritis, and the elderly.
These populations often experience significant short-term mortality due to wasting.
Potential mechanisms include time differentials between competing risks (over- vs. undernutrition), hemodynamic stability, adipokine profiles, and survival selection.

Conclusions:

The cardiovascular risk factor paradox is characteristic of chronic diseases and wasting conditions.
Understanding these similarities may reveal common wasting disease mechanisms.
This could lead to a paradigm shift beyond the Framingham risk model, informing novel therapeutic approaches for wasting and short-term mortality.