The terminology "reverse epidemiology" was first proposed by Kamyar Kalantar-Zadeh in the journal Kidney International in 2003 and in the Journal of the American College of Cardiology in 2004. It is a contradiction to prevailing medical concepts of prevention of atherosclerosis and cardiovascular disease; however, active prophylactic treatment of heart disease in otherwise healthy, asymptomatic people has been and is controversial in the medical community for several years. The mechanism responsible for this reversed association is unknown, but it has been theorized that, in chronic kidney disease patients, "The common occurrence of persistent inflammation and protein energy wasting in advanced CKD chronic kidney disease seems to a large extent to account for this<unk> ical association between traditional risk factors and CV cardiovascular outcomes in this patient population." Other research has proposed that the<unk>  also may be explained by adipose tissue storing lipophilic chemicals that would otherwise be toxic to the body. The<unk>  (excluding the cholesterol<unk>  was first described in 1999 in overweight and obese people undergoing hemodialysis, and has subsequently been found in those with heart failure, myocardial infarction, acute coronary syndrome, chronic obstructive pulmonary disease (COPD),, pulmonary embolisms, and in older nursing home residents. In people with heart failure, those with a body mass index between 30.0–34.9 had lower mortality than those who would normally be considered an ideal weight. This has been attributed to the fact that people often lose weight when they have severe and chronic illness (a syndrome called cachexia). Similar findings have been made in other types of heart disease. People with class I obesity and heart disease do not have greater rates of further heart problems than people of normal weight who also have heart disease. In people with greater degrees of obesity, however, risk of further events is increased. Even after cardiac bypass surgery, no increase in mortality is seen in the overweight and obese. One study found that the improved survival could be explained by the more aggressive treatment obese people receive after a cardiac event. Another found that if one takes into account COPD in those with peripheral artery disease, the benefit of obesity no longer exists. The<unk>  is also relevant in discussion of weight loss as a preventative health measure – weight-cycling (a repeated pattern of losing and then regaining weight) is more common in obese people, and has health effects commonly assumed to be caused by obesity, such as hypertension, insulin resistance, and cardiovascular diseases.
Obesity paradox
Australian paradox
Hispanic paradox
Mexican paradox
French paradox
Low birth-weight paradox
Obesity-associated morbidity
Outcomes paradox