Obesity in Pulmonary Arterial Hypertension. The Pulmonary Hypertension Association Registry

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

“…Nonetheless, the study from Dr. Trammell and colleagues is not only the largest investigation of obesity and PH survival to date, but also the first to expand analysis beyond WSPH Group 1 PAH. 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.…”

“…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 increased level of insulin resistance observed in PAH is not attributed to obesity [113][114][115] . The association between PAH and insulin resistance has been demonstrated across multiple studies.…”

Effect of Obesity on Mortality in Pulmonary Hypertension, Does Obesity Paradox Exist?

“…In the three of the included studies [5,6,9], obese patients tended to have higher pulmonary artery wedge pressures suggesting that they may have occult left ventricular diastolic dysfunction despite meeting criteria for pre-capillary PH at the time of right heart catheterization [13]. In addition, obese patients in the same studies had higher cardiac output [5,8] and lower PVR [5,8] which could also contribute to improved outcomes in these patients [14]. Second, rather than obesity conferring a protective effect, it is also possible that low BMI may simply be a manifestation of declining health due to right ventricular dysfunction.…”

“…Two studies included subjects with pre-capillary PH, post-capillary PH and combined pre and postcapillary PH [3,4], while the other ve studies included only subjects with pre-capillary PH [5][6][7][8][9]. All studies classi ed obese individuals as those with body mass index (BMI) ≥ 30 kg/m 2 .…”

“…All studies classi ed obese individuals as those with body mass index (BMI) ≥ 30 kg/m 2 . Five studies [3,[6][7][8][9] compared obese (BMI ≥ 30 kg/m 2 ) versus non-obese subjects while two studies [4,5] compared obese (BMI ≥ 30 kg/m 2 ) versus normal weight subjects (BMI 18-24.9 kg/m 2 ). We performed a sensitivity analysis by including only studies that included patients with pre-capillary PH.…”