Influence of Obesity on Outcomes in Atrial Fibrillation: Yet Another Obesity Paradox

Badheka, Apurva; Rathod, Ankit; Kizilbash, Mohammad; Garg, Neha; Mohamad, Tamam; Afonso, Luís; Jacob, Sony

doi:10.1016/j.amjmed.2009.11.026

Cited by 186 publications

(89 citation statements)

References 52 publications

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“…Thus, the results of our study could not confirm the obesity paradox that has been reported in several other studies in those with CAD,28, 29, 30, 31, 32 heart failure,33, 34, 35, 36 and atrial fibrillation 37. The obesity paradox was addressed in a large meta‐analysis of patients with CAD, where it was observed that subjects with a low BMI had an increased relative risk for total mortality and cardiovascular mortality, whereas obese patients had no increased risk or even a lower risk for total mortality or cardiovascular mortality 3.…”

Section: Discussioncontrasting

confidence: 99%

Association Between Adiposity and Lean Mass With Long‐Term Cardiovascular Events in Patients With Coronary Artery Disease: No Paradox

Medina‐Inojosa

Somers

Thomas

et al. 2018

JAHA

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BackgroundPrognosis based on body fat percentage (BF%) in patients with coronary artery disease has not been extensively studied. We tested the hypothesis that patients with coronary artery disease and increased BF% have a higher risk for major adverse cardiovascular events (MACEs) and that fat‐free mass is associated with better prognosis.Methods and ResultsWe included 717 patients referred to cardiac rehabilitation after coronary artery disease events or procedures who underwent air displacement plethysmography to assess BF%; 75% were men, with a mean age 61.4±11.4 years and a mean body mass index of 30±5.4 kg/m2. Follow‐up was performed using a record linkage system. Patients were classified in sex‐specific quartiles of BF% and fat‐free mass index. The composite outcome of MACEs included acute coronary syndromes, coronary revascularization, stroke, or death from any cause. After a median follow‐up of 3.9 years, 201 patients had a MACE. After adjusting for covariates, body mass index was not associated with MACEs (P=0.12). However, the risk of MACEs for those in the highest BF% quartile was nearly double when compared with those in the lowest quartile (hazard ratio, 1.89; 95% confidence interval, 1.30–2.77; P=0.0008). In contrast, fat‐free mass was inversely associated with MACEs. The risk of MACEs for those in the fourth fat‐free mass quartile was lower (adjusted hazard ratio, 0.53; 95% confidence interval, 0.35–0.82; P=0.004), when compared with those in the first quartile.ConclusionsIn patients with coronary artery disease, there is no obesity paradox when measuring BF% instead of body mass index. BF% is associated with a higher risk of MACEs, whereas fat‐free mass is associated with a lower risk of MACEs. Body mass index was not associated with MACEs.

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Section: Discussioncontrasting

confidence: 99%

Association Between Adiposity and Lean Mass With Long‐Term Cardiovascular Events in Patients With Coronary Artery Disease: No Paradox

Medina‐Inojosa

Somers

Thomas

et al. 2018

JAHA

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“…These findings were supported by a large meta‐analysis that showed HF patients who were overweight or obese had a significant reduction in all‐cause and cardiovascular mortality 6. The obesity paradox has been reported in other CVD conditions such as hypertension, CAD, and atrial fibrillation 7, 8. This paper reviews the effects that obesity has on cardiovascular function, including the risk of developing and prognosis of HF.…”

Section: Introductionmentioning

confidence: 69%

Obesity paradox in heart failure: a heavy matter

et al. 2016

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Obesity and heart failure are two of the leading causes of morbidity and mortality in the world. The relationship between obesity and cardiovascular diseases is complex and not fully understood. While the risk of developing heart failure has been shown to be higher in patients who are obese, there is a survival advantage for obese and overweight patients compared with normal weight or low weight patients. This phenomenon was first described by Horwich et al. and was subsequently confirmed in other large trials. The advantage exists irrespective of the type, aetiology, or stage of heart failure. Patients with morbid obesity (body mass index >40 kg/m2), however, do not have the same survival advantage of their obese counterparts. There are several alternative indices of obesity available that may be more accurate than body mass index. The role of weight loss in patients with heart failure is unclear; thus, providing sound clinical advice to patients remains difficult. Future prospective trials designed to evaluate the link between obesity and heart failure will help us understand more fully this complex relationship.

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“…15 Investigators increasingly reference an obesity paradox among individuals with chronic diseases, whereby obese persons have higher survival rates compared to non-obese individuals. [16][17][18][19][20][21][22][23][24] Mechanisms for this obesity paradox are not fully understood, but proposed explanations include: 1) sick individuals lose weight and become frail as a result of underlying illnesses that cause wasting; 25 2) obese, sick individuals may have greater cardiorespiratory fitness (a proxy for physical wellness) than non-obese individuals who are also sick, but more likely to be frail and unfit, 26 which is supported by a "surplus calorie theory" hypothesizing that the obese have increased calorie reserves resulting in higher serum lipid levels, less protein/muscle breakdown and less uremia; 27 3) healthy individuals without major disease or injuries experience monotonically increasing mortality risk from excess adiposity, and individuals with major diseases or injuries experience monotonically decreasing mortality risk from excess adiposity; 28,29 4) older obese individuals receive more aggressive treatment that may lead to a potentially false appearance that obesity is protective; and 5) methodological concerns related to residual confounding, survivor bias, and lead-time bias. 25,[30][31][32] Regarding diabetes, it is widely acknowledged that body weight can be influenced by disease duration and weight loss (both intentional and unintentional) following diabetes development/diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Body-Mass Index and All-Cause Mortality in US Adults With and Without Diabetes

et al. 2013

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BACKGROUND: Previous studies found normal weight compared to overweight/obese adults with type 2 diabetes had a higher mortality risk, and body-mass index (BMI)-mortality studies do not typically account for baseline diabetes status. OBJECTIVE: To determine if diabetes influences the BMI-mortality relationship. DESIGN: Using a prospective study design, we analyzed data from a nationally representative sample of US adults participating in the National Health Interview Survey from 1997 to 2002, and followed for mortality through 2006. PARTICIPANTS: Excluding those with heart disease or cancer, our final analytic sample included 74,710 (34,805 never smoker) adults. MAIN MEASURES: BMI was calculated from selfreported height and weight. Diabetes status was based on self-reported diagnosis from a health professional. We used direct age standardization to calculate allcause mortality rates and adjusted Cox models for allcause mortality hazard ratios by BMI quintile; this was done separately for adults with diabetes and without diabetes. KEY RESULTS: Among never smokers, mean age was 50.1 years and 43 % were men. Mean BMI was 27.4 kg/m 2 , 26 % were obese, and 2,035 (5 %) reported diagnosed diabetes. After 9 years, there were 4,355 deaths (754 of 4,740 with diabetes; 3,601 of 69,970 without) among 74,710 participants, and 1,238 (247 of 2,035 with diabetes; 991 of 32,770 without) among 34,805 never smokers. We observed a qualitative interaction with diabetes on the BMImortality relationship (p=0.002). Death rates were substantially higher among participants with diabetes compared to those without diabetes across all BMI quintiles. However, death rates in participants with diabetes fell with increasing BMI quintile, while rates followed a J-shaped curve among those without diabetes. In adjusted Cox models, BMI was positively associated with mortality in adults without diabetes, but inversely associated with mortality among participants with diabetes. CONCLUSIONS: Mortality increased with increasing BMI in adults without diabetes, but decreased with increasing BMI among their counterparts with diabetes. Future studies need to be better designed to answer the question of whether normal weight adults with diabetes have a higher risk of mortality, by minimizing the possibility of reverse causation. Future studies should also account for prevalent diabetes in all investigations of the BMI-mortality relationship.

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Influence of Obesity on Outcomes in Atrial Fibrillation: Yet Another Obesity Paradox

Cited by 186 publications

References 52 publications

Association Between Adiposity and Lean Mass With Long‐Term Cardiovascular Events in Patients With Coronary Artery Disease: No Paradox

Association Between Adiposity and Lean Mass With Long‐Term Cardiovascular Events in Patients With Coronary Artery Disease: No Paradox

Obesity paradox in heart failure: a heavy matter

Body-Mass Index and All-Cause Mortality in US Adults With and Without Diabetes

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