The prognostic impact of general and abdominal obesity in peripheral arterial disease

Abstract

Objective: Obesity is an independent cardiovascular risk factor, but its prognostic role in patients with peripheral arterial disease (PAD) is not well defined. Accordingly, we assessed the impact of body mass index (BMI) and waist circumference (WC) on cardiovascular risk in a homogeneous cohort of PAD patients. Methods: BMI and WC were measured in 190 consecutive PAD patients with ABI o0.90, referred to our university hospital for intermittent claudication. The occurrence of cardiac, cerebrovascular and peripheral events was prospectively assessed. The ability to classify risk was determined by calculating the hazard ratios (HRs) and c-statistics. Results: During a median follow-up of 31.5 months, 63 patients (33.2%) had a cardiovascular event. Considered as continuous variables, both adiposity indices were significantly associated with increased cardiovascular risk, even after adjustment for possible confounding factors (HR ¼ 1.08, 95% CI 1.01-1.15, P ¼ 0.045 for BMI and HR ¼ 1.04, 95% CI 1.01-1.07, P ¼ 0.004 for WC). When BMI and WC were included together in a fully adjusted Cox model, the significant association between BMI and cardiovascular risk disappeared (HR ¼ 0.98, 95% CI 0.88-1.10, P ¼ 0.772), whereas WC remained significantly associated with a worse outcome (HR ¼ 1.04, 95% CI 1.01-1.08, P ¼ 0.033). The better discriminative ability of WC vs BMI was confirmed by the c-statistic, which was significantly higher for WC (0.63, 95% CI 0.56-0.70) than for BMI (0.56, 95% CI 0.51-0.63, P ¼ 0.038). Conclusions: Abdominal obesity and, to a lesser degree, general obesity worsen the prognosis of PAD patients independently of possible confounding factors. Weight reduction should be integrated in the active management of these patients.

The risk of general and abdominal adiposity in the occurrence of new vascular events and mortality in patients with various manifestations of vascular disease

“…The various studies that assessed the association between obesity and vascular events and mortality in PAD patients report different types of relationship, varying from positive relations 10,24 to an obesity paradox. 25 Although obesity altered the risk for vascular mortality and all-cause mortality in CAD and PAD patients, no relationship between obesity and mortality was observed in CVD patients.…”

Effect of limb demand ischemia on autophagy and morphology in mice

“…In obese patients, demand ischemia-induced claudication worsens their prognosis, independent from other compounding factors 1, 2 . Pathologically, demand ischemia in patients with PAD causes repetitive cycles of ischemic injury that exacerbate mitochondrial dysfunction, which induces oxidative stress 3 and gait deficits 4 .…”

The role of nutrition and body composition in peripheral arterial disease

“…103,104,106,108,109,111,113,115,116 All but three of the studies showed that greater total obesity (as measured by BMI) was associated with a greater frequency of adverse PAD-related outcomes. 110,115,117 Of the eight studies in which only BMI was assessed, data from five studies showed that total obesity increased the risk of adverse outcomes, such as a more-rapid decline in peak walking distance 109,111 or a cardiovascular event.…”

“…110–119 Only one study 112 used DEXA body density scans rather than body circumference measurements to assess abdominal adiposity. 110,111,113–119 …”

“…110,115,117 Of the eight studies in which only BMI was assessed, data from five studies showed that total obesity increased the risk of adverse outcomes, such as a more-rapid decline in peak walking distance 109,111 or a cardiovascular event. 113,116 …”