THE OBESITY PARADOX IN DIABETIC CORONARY ARTERY DISEASE: IS BODY MASS INDEX ALONE SUFFICIENT?

Abstract

The obesity paradox remains one of the most controversial concepts in cardiovascular medicine. In this letter, we discuss the recent article by Aydoğan et al. examining the relationship between obesity and coronary artery disease severity in patients with diabetes mellitus. While the study provides valuable evidence supporting the obesity paradox, we highlight several issues that warrant further consideration. Body mass index (BMI) alone may not adequately reflect adiposity or cardiometabolic risk because it does not account for visceral fat distribution or body composition. Furthermore, reverse causation and residual confounding may partially explain the observed associations. We emphasize the importance of incorporating body composition assessment, inflammatory biomarkers, and metabolic health indicators into future studies. Such an approach may provide a more comprehensive understanding of cardiovascular risk stratification in diabetic patients with coronary artery disease.