Influence of obesity on outcomes in atrial fibrillation: yet another obesity paradox

Badkeha, A; Rathod, Ankit; Kizilbash, M. N.; Mohamad, Tamam; Alfonso, Lesly Solís; Jacob, Chandni Maria

doi:10.14341/2071-8713-5096

Cited by 38 publications

(64 citation statements)

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“…A possible explanation of this phenomenon is the use of more aggressive pharmacological interventions in overweight and obese patients, who represent a population with a high prevalence of comorbidities and who require closer management of cardiovascular risks. 36 Furthermore, as reported, plasma renin and angiotensin levels, both of which lead to poor outcomes, are not as high in overweight and obese patients under stress. 56 In addition, Davos et al 57 found that higher BMI could prevent death in AF patients by providing greater metabolic reserve, namely, a better ability to withstand the increased catabolic stress of disease development.…”

Section: Discussionmentioning

confidence: 80%

“…Consistent with this finding, several studies have also demonstrated a decreased risk of AF-related outcomes for each 1-U increase in BMI. 21,30,31,36,41 Most of these studies were conducted in Western populations; however, the obesity standards in Asia differ from those of Western populations, and thus differences by race may exist. Nonetheless, overweight AF patients had a higher survival rate compared with underweight or normalweight patients in a Chinese study.…”

Section: Discussionmentioning

confidence: 99%

“…(2) publication type (2 reviews 27,28 and 1 comment 29 ); (3) BMI not used as a categorical variable (n=3) [30][31][32] or standard BMI classification not reported (n=1) 33 ; (4) study evaluated the effect of BMI on the progression or recurrence of AF (n=2) 6,7 ; (5) "overweight" was used as the reference (n=1) 22 ; (6) study evaluated the effect of BMI on a composite end point of SSE, all-cause death, or cardiovascular death (n=2) 34,35 ; and (7) duplicate data were used (n=1). 36 Finally, 9 studies (1 retrospective cohort study, 5 prospective cohort studies, and 3 post hoc analyses of randomized controlled trials) comprising 49 364 participants were included in this metaanalysis. 18,[37][38][39][40][41][42][43][44] The detailed characteristics of the included studies are provided in Table 1.…”

Section: Study Selectionmentioning

confidence: 99%

See 2 more Smart Citations

Relation of Body Mass Index With Adverse Outcomes Among Patients With Atrial Fibrillation: A Meta‐Analysis and Systematic Review

Zhu

Wan²,

Liu

et al. 2016

JAHA

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Study Selectionmentioning

confidence: 99%

See 1 more Smart Citation

Relation of Body Mass Index With Adverse Outcomes Among Patients With Atrial Fibrillation: A Meta‐Analysis and Systematic Review

Zhu

Wan²,

Liu

et al. 2016

JAHA

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“…This observation, the so-called 'obesity paradox', has been reported in patients with AF, congestive heart failure, coronary heart disease and end-stage kidney disease. [29][30][31][32]. A post-hoc analysis of the ARISTOTLE trial demonstrated a significant risk reduction in all-cause mortality and the composite endpoint of stroke and systemic embolism, myocardial infarction and death in obese compared with non-obese patients [33].…”

Section: Discussionmentioning

confidence: 99%

Association of body weight with efficacy and safety outcomes in phase III randomized controlled trials of direct oral anticoagulants: a systematic review and meta‐analysis

Boonyawat

Caron

et al. 2017

Journal of Thrombosis and Haemostasis

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Essentials The association of body weight and patient-important outcomes remains unknown. Phase III randomized controlled trials of direct oral anticoagulants (DOACs) were searched. Risk of outcomes varying among body weight subgroups is not attributable to anticoagulant type. Dose adjustment of DOACs, outside that recommended, is unlikely to improve the outcomes. Click to hear Dr Braunwald's perspective on antithrombotic therapy in cardiovascular disease SUMMARY: Background Concerns have arisen in direct oral anticoagulant (DOAC)-treated patients about safety and efficacy in extremes of body weight. The aims of this systematic review were to investigate the association of body weight and patient-important outcomes in patients treated with DOACs or warfarin, and to demonstrate the fixed-dose effect of DOACs. Methods MEDLINE and EMBASE were searched until November 2016. Phase III randomized controlled trials (RCTs) using DOACs in atrial fibrillation (AF) and acute venous thromboembolism (VTE) were included. Relative risk and 95% confidence interval were calculated. The pooled estimates were performed using a Mantel-Haenszel random effects model. Results A total of 11 phase III RCTs were included. Low body weight was associated with increased risk of thromboembolism compared with non-low body weight (relative risk [RR], 1.57; 95% confidence interval [CI], 1.34-1.85). High body weight was not associated with risk of thromboembolism compared with non-high body weight (RR, 0.88; 95% CI, 0.63-1.23). The subgroup of AF patients with high body weight had a lower risk of thromboembolism compared with non-high body weight (RR, 0.43; 95% CI, 0.28-0.67). Bleeding outcomes were comparable for all body weight comparisons. There were no clear interactions between types of anticoagulant in all outcomes. Conclusion The pooled effect of both the DOAC and comparison arms was likely to be attributable to differences in baseline thrombotic risk in each body weight category, rather than an effect of the type or dose of DOAC used for each indication. Dose adjustment of DOACs, outside that recommended in the package insert, is unlikely to improve safety or efficacy.

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“…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. It also reviews evidence of the obesity paradox in various stages and types of HF and explores alternative indices of obesity.…”

Section: Introductionmentioning

confidence: 99%

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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Influence of obesity on outcomes in atrial fibrillation: yet another obesity paradox

Cited by 38 publications

References 0 publications

Relation of Body Mass Index With Adverse Outcomes Among Patients With Atrial Fibrillation: A Meta‐Analysis and Systematic Review

Relation of Body Mass Index With Adverse Outcomes Among Patients With Atrial Fibrillation: A Meta‐Analysis and Systematic Review

Association of body weight with efficacy and safety outcomes in phase III randomized controlled trials of direct oral anticoagulants: a systematic review and meta‐analysis

Obesity paradox in heart failure: a heavy matter

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