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Fun Fact: Cardiovascular paradox. What are they? Why do they happen? Much there is still to learn!

Updated: Dec 6, 2022

What is a paradox?

A paradox is where conventional knowledge cannot explain an unusual or opposite response that occurs.

What is a cardiovascular paradox?

A cardiovascular paradox is a paradox that occurs in relation to the physiology and mechanics of the heart and vascular system.

Usually, these paradoxes are not due to errors in data analysis or failing to account for significant factors that will affect the data [1].

Cardiovascular paradoxes are usually identified when an expected outcome is wholly opposed to what was expected or if a clinical outcome changes depending on age.

What are some examples of cardiovascular paradoxes?

Cognitive impairment paradox [2]

High blood pressure has an increased risk for cognitive impairment for younger adults, while high blood pressure appears to have a protective factor for cognitive health in older adults

Physical activity paradox [1, 3]

Higher leisure time physical activity is associated with reduced major adverse cardiovascular events, while higher occupational (work-related) physical activity is associated with increased risk for major adverse cardiovascular events [1]

Obesity paradox [4, 5]

Those who are overweight or obese appear to have a better prognosis for established cardiovascular diseases, which include hypertension, heart failure, congestive heart failure and peripheral artery disease, than those who are non-overweight or non-obese [4]

Why do they happen?

It is difficult to conclusively determine why cardiovascular paradoxes occur. While some may originate from a physiological adaptation that results from prolonged exposure to certain conditions or internal environment, limited definitive proof exists to draw conclusions.

However, it is critical that we identify these cardiovascular paradoxes to ensure that appropriate treatment regimens and management strategies are being utilised.

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[1] Holtermann A, Schnohr P, Nordestgaard BG, Marott JL. The physical activity paradox in cardiovascular disease and all-cause mortality: the contemporary Copenhagen General Population Study with 104 046 adults. European Heart Journal. 2021;42(15):1499-511.

[2] Forte G, De Pascalis V, Favieri F, Casagrande M. Effects of Blood Pressure on Cognitive Performance: A Systematic Review. Journal of Clinical Medicine. 2019;9(1):34.

[3] Holtermann A, Hansen JV, Burr H, Søgaard K, Sjøgaard G. The health paradox of occupational and leisure-time physical activity. British Journal of Sports Medicine. 2012;46(4):291-5.

[4] Lavie CJ, Milani RV, Ventura HO. Obesity and Cardiovascular Disease. Journal of the American College of Cardiology. 2009;53(21):1925-32.

[5] Elagizi A, Kachur S, Lavie CJ, Carbone S, Pandey A, Ortega FB, et al. An Overview and Update on Obesity and the Obesity Paradox in Cardiovascular Diseases. Progress in Cardiovascular Diseases. 2018;61(2):142-50.

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