Abstract
HomeCirculationVol. 144, No. 1Response by Hendren et al to Letter Regarding Article, “Association of Body Mass Index and Age With Morbidity and Mortality in Patients Hospitalized With COVID-19: Results From the American Heart Association COVID-19 Cardiovascular Disease Registry” Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBResponse by Hendren et al to Letter Regarding Article, “Association of Body Mass Index and Age With Morbidity and Mortality in Patients Hospitalized With COVID-19: Results From the American Heart Association COVID-19 Cardiovascular Disease Registry” Nicholas S. Hendren, MD, James A. de Lemos, MD and Justin L. Grodin, MD, MPH Nicholas S. HendrenNicholas S. Hendren https://orcid.org/0000-0002-0551-7864 Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas. Parkland Health and Hospital System, Dallas, TX. Search for more papers by this author , James A. de LemosJames A. de Lemos https://orcid.org/0000-0003-2211-7261 Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas. Parkland Health and Hospital System, Dallas, TX. Search for more papers by this author and Justin L. GrodinJustin L. Grodin https://orcid.org/0000-0003-2400-3196 Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas. Parkland Health and Hospital System, Dallas, TX. Search for more papers by this author Originally published6 Jul 2021https://doi.org/10.1161/CIRCULATIONAHA.121.054556Circulation. 2021;144:e8–e9In Response:We read with interest the letter by Yuping Li and Guangyu Lu in which they query whether an obesity paradox may exist for coronavirus disease 2019 (COVID-19). As the letter writers note, the obesity paradox has been described for several acute and chronic cardiovascular and pulmonary conditions, whereas overweight or mildly obese individuals may paradoxically have fewer adverse outcomes compared with individuals of normal weight.1 To date, however, an obesity paradox for hospitalization, risk for mechanical ventilation, and all-cause death has not been observed in COVID-19.2–4 The 2 largest studies have observed a greater dose-dependent risk for mechanical ventilation with increasing body mass index despite adjustment for patient risk factors.3,4 Likewise, a recent Centers for Disease Control study observed a greater dose-dependent risk of all-cause death in class I, II, or III obese individuals compared with either normal or overweight World Health Organization obesity classes.4 Accordingly, the relationship of body weight to risk for severe COVID-19 may be distinct from previously described populations for which the obesity paradox has been described. The relatively low rate of cardiovascular complications likely reflects the overall short follow-up period (index hospitalization), the high competing risk of death, and the practical challenges of diagnosing an acute stroke, heart failure, or myocardial infarction in the setting of an acute lung injury or critical illness.Because of the rapid acute lung injury in COVID-19, the direct association of body weight with adverse respiratory mechanics and cytokine production may increase the risk for mechanical ventilation, irrespective of baseline body fitness.5 Although it is plausible that high cardiorespiratory fitness may mitigate some of the hazards of obesity in patients with COVID-19, we cannot address this question because fitness was not captured in our dataset. Additionally, “obese but fit” likely represent a small proportion of the world’s obese population. In our cohort, overweight and obese individuals hospitalized with COVID-19 had a high comorbid disease burden of diabetes, hypertension, and previous cardiovascular disease representative of an obese and unfit population.3 We believe the most prudent approach is to recognize that all obese individuals are at high risk for severe COVID-19 regardless of fitness and to encourage physical activity, weight loss, and COVID-19 vaccination.Disclosures Dr Grodin has received consulting fees from Pfizer, Eidos Therapeutics, Sarepta Therapeutics, and Alnylam Pharmaceuticals and research funding from Eidos Therapeutics and the Texas Health Resources Clinical Scholars fund. Dr de Lemos has received grant support from Roche Diagnostics and Abbott Diagnostics and consulting income from Siemens Health Care Diagnostics, Ortho Clinical Diagnostics, Quidel, and Regeneron. Dr Hendren reports no conflicts.Footnoteshttps://www.ahajournals.org/journal/circ
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