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Potential Reasons for the Obesity Paradox in AF
1. Nonpurposeful weight loss
2. Greater metabolic reserves
3. Less cachexia
4. Protective cytokines
5. Earlier presentation∗
6. Attenuated response to renin-angiotensin-aldosterone system
7. Higher blood pressure leading to more cardiac medications
8. Different cause of CVD and AF
9. Increase muscle mass and muscular strength
10. Implications related to cardiorespiratory fitness
11. Confounders and collider bias
AF = atrial fibrillation; CVD = cardiovascular disease.
↵∗ Caused by lower atrial natriuretic peptide levels, restrictive lung disease, venous insufficiency, and so on.