Key result
Obesity in DMD is linked to myocardial fibrosis and ~275% higher risk of adverse cardiac outcomes.
Why the study?
Cardiomyopathy progression is the primary cause of mortality in Duchenne muscular dystrophy, but the specific role of highly prevalent obesity in cardiac deterioration remains undetermined.
Does obesity increase the risk of myocardial fibrosis and adverse cardiac outcomes in boys with Duchenne muscular dystrophy?
Does obesity increase the risk of myocardial fibrosis and adverse cardiac outcomes in boys with Duchenne muscular dystrophy?
Obesity is an independent predictor of myocardial fibrosis and adverse cardiac outcomes in boys with Duchenne muscular dystrophy, highlighting the need for early weight management.
May inform weight management in DMD; leaves open whether reducing obesity improves fibrosis or outcomes.
Background Cardiomyopathy progression remains the predominant cause of mortality in Duchenne muscular dystrophy (DMD), with myocardial fibrosis serving as its central pathological hallmark. While obesity is highly prevalent in DMD patients and correlates with clinical outcomes, its specific role in cardiac deterioration remains undetermined. Purpose To investigate the association between obesity and myocardial fibrosis, as well as its prognostic impact on clinical cardiac outcomes in Chinese DMD patients. Methods A prospective cohort study was conducted using cardiac magnetic resonance imaging (CMR) assessment. Obesity was defined by BMI z-scores ≥95th percentile for age. Myocardial fibrosis was determined through late gadolinium enhancement (LGE) on CMR. Composite cardiac endpoints included dilated cardiomyopathy, left ventricular ejection fraction (LVEF) <50%, heart failure hospitalization, recurrent angina, ventricular arrhythmias, or all-cause mortality. Multivariable linear regression and Cox proportional hazards models were employed to identify independent predictors. Results A total of 198 boys with DMD (age: 8.0 years [IQR 7.0, 10.0]) were included, of whom 26.3% were classified as obese (median BMI: 21.3 [IQR 20.4-23.0]). Multivariable linear regression analysis revealed a significant association between obesity and LGE (adjusted OR: 3.57, 95% CI: 1.66, 7.71, p = 0.001). During a mean follow - up period of 38.3 ± 14.1 months, 28 boys reached cardiac endpoint. Multivariable Cox model analysis indicated that obesity (adjusted HR: 3.75, 95% CI: 1.57, 8.97, p = 0.003) and baseline LVEF (adjusted HR: 0.90, 95% CI: 0.85, 0.97, p = 0.003) were independently associated with cardiac endpoints. Conclusion Obesity independently associates with myocardial fibrosis and adverse cardiac outcomes in Chinese DMD patients. These findings underscore the imperative for early weight management strategies in multidisciplinary DMD care.
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Zhang et al. (2025) studied this question. Obesity in Chinese DMD patients is independently associated with a 3.57-fold higher odds of myocardial fibrosis and a 3.75-fold increased risk of adverse cardiac outcomes.
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