Aging Clinical and Experimental Research

, Volume 30, Issue 6, pp 547–554 | Cite as

The reverse metabolic syndrome in the elderly: Is it a “catabolic” syndrome?

  • Francesco Curcio
  • Giuseppe Sasso
  • Ilaria Liguori
  • Gaetana Ferro
  • Gennaro Russo
  • Michele Cellurale
  • David Della-Morte
  • Gaetano Gargiulo
  • Gianluca Testa
  • Francesco Cacciatore
  • Domenico Bonaduce
  • Pasquale Abete


Traditional risk factors of cardiovascular death in the general population, including body mass index (BMI), serum cholesterol, and blood pressure are also found to relate to outcomes in the geriatric population, but in a differing direction. A higher body mass index, hypercholesterolemia and hypertension are not harmful but even permit better survival at advancing age. This phenomenon is called “reverse epidemiology” or “risk factor paradox” and is also detected in a variety of chronic disease states such as chronic heart failure. Accordingly, a low BMI, blood pressure and cholesterol values are associated with a worse prognosis. Several possible causes are hypothesized to explain this elderly paradox, but this phenomenon remains controversial and its underlying reasons are poorly understood. The aim of this review is to recognize the factors behind this intriguing phenomenon and analyse the consequences that it can bring in the management of the cardiovascular therapy in elderly patient. Finally, a new phenotype identified as “catabolic syndrome” has been postulated.


Body mass index Blood pressure Cholesterol Reverse epidemiology Catabolic syndrome 


Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Statement of human and animal rights

All applicable international, national, and/or institutional guidelines for the care and use of animals were followed.

Informed consent

Informed consent was obtained from all individual participants included in the review.


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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Francesco Curcio
    • 1
  • Giuseppe Sasso
    • 1
  • Ilaria Liguori
    • 1
  • Gaetana Ferro
    • 2
  • Gennaro Russo
    • 1
  • Michele Cellurale
    • 1
  • David Della-Morte
    • 3
    • 4
  • Gaetano Gargiulo
    • 5
  • Gianluca Testa
    • 1
    • 6
  • Francesco Cacciatore
    • 1
    • 7
  • Domenico Bonaduce
    • 1
  • Pasquale Abete
    • 1
  1. 1.Department of Translational Medical SciencesUniversity of Naples “Federico II”NaplesItaly
  2. 2.Department of EmergencyA.O.R.N. Antonio CardarelliNaplesItaly
  3. 3.Department of Systems MedicineUniversity of Rome Tor VergataRomeItaly
  4. 4.San Raffaele Roma Open UniversityRomeItaly
  5. 5.Division of Internal MedicineAOU San Giovanni di Dio e Ruggi di AragonaSalernoItaly
  6. 6.Department of Medicine and Health SciencesUniversity of MoliseCampobassoItaly
  7. 7.Heart Transplantation Unit, Monaldi HospitalAzienda Ospedaliera dei ColliNaplesItaly

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