Obesity and Quality of Life in Pulmonary Arterial Hypertension (PAH): The Pulmonary Hypertension Association Registry (PHAR)

Risk assessment in patients with pulmonary arterial hypertension in the era of COVID 19 pandemic and the telehealth revolution: State of the art review

“…Given the treatment-related benefits in HRQoL observed in patients with PAH, mounting evidence implicates a future role for improved HRQoL as a prognostic marker in PAH 49 . A recent study from the Pulmonary Hypertension Association Registry (PHAR) showed that PAH patients judged at high risk by COMPERA and REVEAL 2.0 risk assessment tools had greater risk of death and hospitalization, and had worse disease-specific health related quality of life, as assessed by the em-PHasis-10 and Medical Outcome Study Short Form-12 (SF-12) general physical and mental component scores 50 . Another randomized study (NCT03078907) of selexipag vs. placebo in functional class II PAH patients used accelerometry (GT9X Link, ActiGraph), along with PAH-SYMPACT to assess daily physical activity 51 .Although this study did not meet its primary endpoint, it did provide important insight into using accelerometers and PROs in assessing activity in PAH patients, As such, these findings are intriguing and suggest a potential role for PRO tools in management of PAH, telemedical or otherwise.…”

What’s new in pulmonary hypertension clinical research: lessons from the best abstracts at the 2020 American Thoracic Society International Conference

“… 111 Although obesity is common in PAH and associated with more significant functional impairment early in the disease course, obese patients paradoxically have better survival than those with normal weight. 109 , 112 While obesity has been linked to insulin resistance in non-diabetic individuals, evidence suggests that the increased level of insulin resistance observed in PAH is not attributed to obesity. 113 – 115 The association between PAH and insulin resistance has been demonstrated across multiple studies.…”

“…Their finding of improved survival among overweight and obese PH patients is in agreement with data from prior PAH cohorts. 109 , 112 During his presentation, Dr. Trammell cautioned that a causal relationship cannot be confirmed between BMI and mortality risk. Moreover, the findings do not suggest that weight gain is beneficial and translates to better PH outcomes.…”

“…Prior evidence also signals that the “obesity paradox” is applicable in PAH, a phenomenon that has been described in multiple other cardiovascular disease states 111 . Although obesity is common in PAH and associated with more significant functional impairment early in the disease course, obese patients paradoxically have better survival than those with normal weight 109 , 112 . While obesity has been linked to insulin resistance in non‐diabetic individuals, evidence suggests that the increased level of insulin resistance observed in PAH is not attributed to obesity 113 – 115 .…”

Risk Stratification in Pulmonary Arterial Hypertension: Do Not Forget the Patient Perspective

“…What is unclear is whether risk assessment tools can predict patient reported outcomes and future hospitalizations. It is this important question which Min et al (6) address in their study of 869 PAH patients who were prospectively enrolled in the Pulmonary Hypertension Association Registry (PHAR). Two HRQoL instruments (Medical Outcomes Study Short Form-12, SF-12 and emPHasis-10) were administered at baseline and follow-up visits.…”