Linked Life Data

17991210

Source:http://linkedlifedata.com/resource/pubmed/id/17991210

Statements in which the resource exists as a subject.
PredicateObject
rdf:type
lifeskim:mentions
pubmed:issue
6
pubmed:dateCreated
2007-11-9
pubmed:abstractText
The term "reverse epidemiology" is used to indicate that such surrogates of cardiovascular risk and metabolic syndrome as obesity, hypercholesterolemia and hypertension are paradoxically associated with greater survival in individuals with chronic disease states and wasting, including dialysis patients, in whom the short-term survival is the issue at hand. It is being debated whether the crossing curves of the obesity-mortality association in dialysis patients vs. the general population reflect the residual confounding that needs to be controlled away statistically, or whether they have biological plausibility in sharp contradistinction to the currently dominating Framingham paradigm. In the rush to define the crossing curves as statistical artifact and to dismiss the term "reverse epidemiology" as a misnomer, we may miss the opportunity to gain information housed in those crossing lines and may miss the bigger picture, i.e., how to improve longevity in dialysis patients. Even though some of the survival paradoxes in dialysis patients appear to fulfill the Hill's criteria of causation, there are still two major drawbacks: (1) convincing pathophysiologic pathways to link dialysis patient survival to obesity, fat accumulation, higher serum lipoprotein levels or slightly higher than normal blood pressure values are yet to be verified in animal and other scientifically sound models; and (2) randomized controlled trials need to show that nutritional interventions resulting in weight gain can lead to greater survival in dialysis patients. Studying the survival paradoxes may lead to a paradigm shift by establishing targets beyond the Framingham guidelines for populations with chronic disease states.
pubmed:grant
pubmed:language
eng
pubmed:journal
pubmed:citationSubset
IM
pubmed:status
MEDLINE
pubmed:issn
0894-0959
pubmed:author
pubmed:issnType
Print
pubmed:volume
20
pubmed:owner
NLM
pubmed:authorsComplete
Y
pubmed:pagination
593-601
pubmed:dateRevised
2011-9-22
pubmed:meshHeading
pubmed:articleTitle
What is so bad about reverse epidemiology anyway?
pubmed:affiliation
Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, Los Angeles Biomedical Research Center at Harbor-UCLA, Torrance, USA. kamkal@ucla.edu
pubmed:publicationType
Journal Article, Review, Research Support, Non-U.S. Gov't, Research Support, N.I.H., Extramural