The obesity paradox consists basically on the opposite of what happens in primary prevention; that is in secondary prevention settings such as heart failure and coronary syndrome, the obese have a better prognosis than the normoweight. However, in the largest cohort (1.46 million non-Hispanic white subjects with or without cardiovascular disease), in which the relationship between BMI and mortality was analyzed, showed that overweight and obesity are associated with an increase in all mortality causes. We have also warned that there may be bias in the studies that have reported the Obesity Paradox, as they, in the multivariate analysis, do not always include important prognostic factors associated with: renal function, the clinical severity of the acute event (functional class, left ventricular ejection fraction, etc.) biomarkers (cardiac enzymes, B natriuretic peptide, cystatin C, C-reactive Protein, etc.) and the "complex" pharmacological variables (dose, serum concentrations, adverse effects, etc.).The need to analyze this and other epidemiological paradoxes has even led to the organization of a 1st World Symposium on Cardiovascular Paradoxes.

http://promociondeeventos.sld.cu/cardiocirugia2011/i-simposio-de-paradojas-cardiovasculares