The impact of underweight and obesity on outcomes in anticoagulated patients with atrial fibrillation: A systematic review and meta‐analysis on the obesity paradox

Grymonprez, Maxim; Capiau, Andreas; Backer, Tine L. De; Steurbaut, Stéphane; Boussery, Koen; Lahousse, Lies

doi:10.1002/clc.23593

Cited by 15 publications

(14 citation statements)

References 45 publications

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“…Obesity is a risk factor for ischemic stroke; its effect on treatment outcomes in AIS patients is unclear [ 45 ]. The description of obesity categories is based on body mass index (BMI), and a U-shaped association between BMI and stroke has been reported [ 46 ]. However, other studies [ 47 , 48 ] support the paradoxical concept of relative longevity in obese patients with stroke.…”

Section: Discussionmentioning

confidence: 99%

Age Stratification and Stroke Severity in the Telestroke Network

Simmons

Poupore

Nathaniel

2023

JCM

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Background. Age is one of the most important risk factors for stroke, and an estimated 75% of strokes occur in people 65 years old and above. Adults > 75 years of age experience more hospitalizations and higher mortality. In this study, we aimed to investigate how age and various clinical risk factors affect acute ischemic stroke (AIS) severity in two age categories. Methods. This retrospective data analysis study was conducted using data collected from the PRISMA Health Stroke Registry between June 2010 and July 2016. Baseline clinical and demographic data were analyzed for 65–74-year-old patients and those ≥ 75 years of age. This study aimed to investigate risk factors associated with stroke severity in these two age categories of AIS patients treated in telestroke settings. Results. An adjusted multivariate analysis showed that the acute ischemic stroke (AIS) population of 65–74-year-old patients experiencing heart failure (odds ratio (OR) = 4.398, 95% CI = 3.912–494.613, p = 0.002) and elevated high-density lipoprotein (HDL) levels (OR = 1.066, 95% CI = 1.009–1.126, p = 0.024) trended towards worsening neurological function, while patients experiencing obesity (OR = 0.177, 95% CI = 0.041–0.760, p = 0.020) exhibited improved neurological functions. For the patients ≥ 75 years of age, direct admission (OR = 0.270, 95% CI = 0.085–0.856, p = 0.026) was associated with improved functions. Conclusions. Heart failure and elevated HDL levels were significantly associated with worsening neurologic functions in patients aged 65–74. Obese patients and individuals ≥ 75 years of age who were directly admitted were most likely to exhibit improving neurological functions.

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Section: Discussionmentioning

confidence: 99%

Age Stratification and Stroke Severity in the Telestroke Network

Simmons

Poupore

Nathaniel

2023

JCM

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“…Using a simple search, we found 14 meta-analyses that also explored the association between BMI and mortality: 3 each in heart failure [193][194][195] and percutaneous coronary intervention, [196][197][198] 1 in atrial fibrillation, 199 1 in acute coronary syndrome, 200 1 in aortic stenosis, 201 1 in type 2 diabetes, 202 1 in colorectal cancer, 203 1 in lung cancer, 204 1 in acute respiratory distress, 7 and 1 in pneumonia. 205 All found that BMI in the overweight and obesity range was associated with significantly lower mortality as compared to BMI 18-25 kg/m 2 .…”

Section: Support From Other Studiesmentioning

confidence: 99%

Associations between body mass index and all‐cause mortality: A systematic review and meta‐analysis

2023

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SummaryFasting insulin and c‐reactive protein confound the association between mortality and body mass index. An increase in fat mass may mediate the associations between hyperinsulinemia, hyperinflammation, and mortality. The objective of this study was to describe the “average” associations between body mass index and the risk of mortality and to explore how adjusting for fasting insulin and markers of inflammation might modify the association of BMI with mortality. MEDLINE and EMBASE were searched for studies published in 2020. Studies with adult participants where BMI and vital status was assessed were included. BMI was required to be categorized into groups or parametrized as non‐first order polynomials or splines. All‐cause mortality was regressed against mean BMI squared within seven broad clinical populations. Study was modeled as a random intercept. β coefficients and 95% confidence intervals are reported along with estimates of mortality risk by BMIs of 20, 30, and 40 kg/m2. Bubble plots with regression lines are drawn, showing the associations between mortality and BMI. Splines results were summarized. There were 154 included studies with 6,685,979 participants. Only five (3.2%) studies adjusted for a marker of inflammation, and no studies adjusted for fasting insulin. There were significant associations between higher BMIs and lower mortality risk in cardiovascular (unadjusted β −0.829 [95% CI −1.313, −0.345] and adjusted β −0.746 [95% CI −1.471, −0.021]), Covid‐19 (unadjusted β −0.333 [95% CI −0.650, −0.015]), critically ill (adjusted β −0.550 [95% CI −1.091, −0.010]), and surgical (unadjusted β −0.415 [95% CI −0.824, −0.006]) populations. The associations for general, cancer, and non‐communicable disease populations were not significant. Heterogeneity was very large (I2 ≥ 97%). The role of obesity as a driver of excess mortality should be critically re‐examined, in parallel with increased efforts to determine the harms of hyperinsulinemia and chronic inflammation.

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“…Current available evidence on NVAF patients with UW presents contradictory results [12][13][14][15][16][17]. Data derived from a meta-analysis by Grymonprez et al demonstrated a significant higher incidence of stroke or thromboembolic events and mortality risks in UW NVAF populations.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Apixaban standard dosing in underweight patients with non-valvular atrial fibrillation: a retrospective cohort study

Sulaiman,

Aljuhani,

Alkofide

et al. 2024

Thrombosis J

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Background Recent guidelines recommend using direct oral anticoagulants (DOACs) as first-line agents in patients with non-valvular atrial fibrillation (NVAF). Research is currently investigating the use of Apixaban in underweight patients, with some results suggesting altered pharmacokinetics, decreased drug absorption, and potential overdosing in this population. This study examined the effectiveness and safety of standard Apixaban dosing in adult patients with atrial NVAF weighing less than 50 kg. Methods This is a retrospective cohort study conducted at King Abdulaziz Medical City (KAMC); adult patients with a body mass index (BMI) below 25 who received a standard dose of Apixaban (5 mg twice daily) were categorized into two sub-cohorts based on their weight at the time of Apixaban initiation. Underweight was defined as patients weighing ≤ 50 kg, while the control group (Normal weight) comprised patients weighing > 50 kg. We followed the patients for at least one year after Apixaban initiation. The study’s primary outcome was the incidence of stroke events, while secondary outcomes included bleeding (major or minor), thrombosis, and venous thromboembolism (VTE). Propensity score (PS) matching with a 1:1 ratio was used based on predefined criteria and regression model was utilized as appropriate. Results A total of 1,433 patients were screened; of those, 277 were included according to the eligibility criteria. The incidence of stroke events was lower in the underweight than in the normal weight group at crude analysis (0% vs. 9.1%) p-value = 0.06), as well in regression analysis (OR (95%CI): 0.08 (0.001, 0.76), p-value = 0.002). On the other hand, there were no statistically significant differences between the two groups in the odds of major and minor bleeding (OR (95%CI): 0.39 (0.07, 2.03), p-value = 0.26 and OR (95%CI): 1.27 (0.56, 2.84), p-value = 0.40, respectively). Conclusion This exploratory study revealed that underweight patients with NVAF who received standard doses of Apixaban had fewer stroke events compared to normal-weight patients, without statistically significant differences in bleeding events. To confirm these findings, further randomized controlled trials with larger sample sizes and longer observation durations are required.

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The impact of underweight and obesity on outcomes in anticoagulated patients with atrial fibrillation: A systematic review and meta‐analysis on the obesity paradox

Cited by 15 publications

References 45 publications

Age Stratification and Stroke Severity in the Telestroke Network

Age Stratification and Stroke Severity in the Telestroke Network

Associations between body mass index and all‐cause mortality: A systematic review and meta‐analysis

Evaluation of Apixaban standard dosing in underweight patients with non-valvular atrial fibrillation: a retrospective cohort study

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