THE OBESITY PARADOX IN DIABETIC CORONARY ARTERY DISEASE: IS BODY MASS INDEX ALONE SUFFICIENT?

Öz

The obesity paradox remains one of the most controversial concepts in cardiovascular medicine. In this letter, we discuss the recent article by Aydoğan et al. examining the relationship between obesity and coronary artery disease severity in patients with diabetes mellitus. While the study provides valuable evidence supporting the obesity paradox, we highlight several issues that warrant further consideration. Body mass index (BMI) alone may not adequately reflect adiposity or cardiometabolic risk because it does not account for visceral fat distribution or body composition. Furthermore, reverse causation and residual confounding may partially explain the observed associations. We emphasize the importance of incorporating body composition assessment, inflammatory biomarkers, and metabolic health indicators into future studies. Such an approach may provide a more comprehensive understanding of cardiovascular risk stratification in diabetic patients with coronary artery disease.

Anahtar Kelimeler

• Obesity paradox
• Diabetes mellitus
• Coronary artery disease

Kaynakça

1. Aydoğan M, Yavuz ML, Şenkal N, Karaca Özer P, Emet S, Köse M, et al. The obesity paradox in the coexistence of diabetes and coronary artery disease. J Ist Faculty Med 2026;89(2):123-6. google scholar
2. Chang VW, Langa KM, Weir D, Iwashyna TJ. The obesity paradox and incident cardiovascular disease: A population-based study. PLoS One 2017;12(12):e0188636. google scholar
3. Nalini M, Sharafkhah M, Poustchi H, Sepanlou SG, Pourshams A, Radmard AR, et al. Comparing anthropometric ındicators of visceral and general adiposity as determinants of overall and cardiovascular mortality. Arch Iran Med 2019;22(6):301-9. google scholar
4. Simati S, Kokkinos A, Dalamaga M, Argyrakopoulou G. Obesity paradox: fact or fiction?. Curr Obes Rep 2023;12(2):75-85. google scholar
5. Eckel N, Meidtner K, Kalle-Uhlmann T, Stefan N, Schulze MB. Metabolically healthy obesity and cardiovascular events: A systematic review and meta-analysis. Eur J Prev Cardiol 2016;23(9):956-66. google scholar