The association between obesity, mortality and filling pressures in pulmonary hypertension patients; the “obesity paradox”

Abstract

Obesity was significantly associated with lower mortality in both pre-capillary and disproportional post-capillary PH patients. It seems that in PH, similarly to other chronic clinical cardiovascular disease states, there may be a protective effect of obesity, compatible with the "obesity paradox".

Obesity paradox in group 1 pulmonary hypertension: analysis of the NIH-Pulmonary Hypertension registry

“…13 The obesity–mortality association was observed in their study despite the disparate PH groups, with fundamentally varied pathophysiological processes; our findings differ remarkably from the aforementioned study by Zafir et al . 13 (who included both pre-and postcapillary PH) in that patients in the current study were rigorously evaluated and all secondary causes of PH were excluded and could therefore be appropriately classified into group 1 PH under the current PH guidelines.…”

“…36 demonstrated the modulating effects of obesity on mortality in patients with PAH treated with subcutaneous treprostinil. These patients were observed to have a statistically significant survival advantage compared with their non-obese counterparts, a finding that was also mirrored by Zafir et al ., 13 when they showed that obesity had salutary effects on mortality in both pre- and postcapillary PH. 13 The obesity–mortality association was observed in their study despite the disparate PH groups, with fundamentally varied pathophysiological processes; our findings differ remarkably from the aforementioned study by Zafir et al .…”

“…These patients were observed to have a statistically significant survival advantage compared with their non-obese counterparts, a finding that was also mirrored by Zafir et al ., 13 when they showed that obesity had salutary effects on mortality in both pre- and postcapillary PH. 13 The obesity–mortality association was observed in their study despite the disparate PH groups, with fundamentally varied pathophysiological processes; our findings differ remarkably from the aforementioned study by Zafir et al . 13 (who included both pre-and postcapillary PH) in that patients in the current study were rigorously evaluated and all secondary causes of PH were excluded and could therefore be appropriately classified into group 1 PH under the current PH guidelines.…”

Five-Year Outcomes of Patients Enrolled in the REVEAL Registry

“…These secondary analyses included patients with missing FC categorization. Finally, in a potential instance of the "obesity paradox," 16 Table 3). As expected, known risk factors including baseline 6MWD, mRAP, and brain natriuretic peptide were associated with survival ( Table 3).…”

Comparison of body mass index and body surface area as outcome predictors in patients with systolic heart failure

“…However, numerous studies have demonstrated over the years that in patients with existing HF, obesity is unexpectedly associated with better survival [4][5][6][7][8][9]. This notion that overweight and obese individuals have survival advantage compared with leaner subjects was reported in addition to HF in several other chronic CV disease conditions and is named the 'obesity paradox' [10,11].…”