Reverse Epidemiology of Traditional Cardiovascular Risk Factors in the Geriatric Population

Seyed Foad Ahmadi, Elani Streja, Golara Zahmatkesh, Dan Streja, Moti Kashyap, Hamid Moradi, Miklos Z. Molnar, Uttam Reddy, Alpesh N. Amin, Csaba P. Kovesdy, Kamyar Kalantar-Zadeh

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58 Citations (Scopus)


Traditional risk factors of cardiovascular death in the general population, including body mass index (BMI), serum cholesterol, and blood pressure (BP), are also found to relate to outcomes in the geriatric population, but in an opposite direction. Some degrees of elevated BMI, serum cholesterols, and BP are reportedly associated with lower, instead of higher, risk of death among the elderly. This phenomenon is termed "reverse epidemiology" or "risk factor paradox" (such as obesity paradox) and is also observed in a variety of chronic disease states such as end-stage renal disease requiring dialysis, chronic heart failure, rheumatoid arthritis, and AIDS. Several possible causes are hypothesized to explain this risk factor reversal: competing short-term and long-term killers, improved hemodynamic stability in the obese, adipokine protection against tumor necrosis factor-α, lipoprotein protection against endotoxins, and lipophilic toxin sequestration by the adipose tissue. It is possible that the current thresholds for intervention and goal levels for such traditional risk factors as BMI, serum cholesterol, and BP derived based on younger populations do not apply to the elderly, and that new levels for such risk factors should be developed for the elderly population. Reverse epidemiology of conventional cardiovascular risk factors may have a bearing on the management of the geriatric population, thus it deserves further attention.

Original languageEnglish
Pages (from-to)933-939
Number of pages7
JournalJournal of the American Medical Directors Association
Issue number11
Publication statusPublished - Nov 1 2015


  • Cardiovascular risk factors
  • Mortality
  • Obesity paradox
  • Reverse epidemiology
  • Risk factor paradox

ASJC Scopus subject areas

  • Nursing(all)
  • Health Policy
  • Geriatrics and Gerontology

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  • Cite this

    Ahmadi, S. F., Streja, E., Zahmatkesh, G., Streja, D., Kashyap, M., Moradi, H., Molnar, M. Z., Reddy, U., Amin, A. N., Kovesdy, C. P., & Kalantar-Zadeh, K. (2015). Reverse Epidemiology of Traditional Cardiovascular Risk Factors in the Geriatric Population. Journal of the American Medical Directors Association, 16(11), 933-939.