Concerning the Role of Gender Difference in Obesity Paradox in Patients With Heart Failure.

(CVD) risk factors, CV structure and function, and increases the prevalence of most CVD, including coronary heart disease (CHD) and heart failure (HF) (2,3). Nevertheless, we reported an obesity paradox in 6 studies of 22,807 patients with HF (4); a metaanalysis of 89 studies in 1.3 million patients with established CHD which confirmed a strong obesity paradox (5); and a meta-analysis by Flegal et al. (6) of 97 studies in 2.9 million people which showed that overweight subjects had a significant 6% lower mortality than subjects with normal body mass index, and that class I obesity had a strong trend of 5% lower mortality. Therefore, denying the obesity paradox in 2015 is foolish in our opinion and represents a “headin-the-sand” position, although certainly confounding factors may be involved. Additionally, we believe that despite the obesity paradox, intentional weight loss, especially in more severe obesity, would be advantageous. There is some suggestion that intentional weight loss may reduce major clinical endpoints in CHD and in the general population (2). Weight loss also improves hemodynamics, CV structure and function, and functional classification in HF, but we are not aware of any data to prove that weight reduction reduces major clinical end-points. Nevertheless, in a perfect world, maintaining high fitness and prevention of weight gain in children, adolescents, and adults would go a long way in the prevention and treatment of most CVD, including HF (2,3).