The ‘obesity paradox’ in atrial fibrillation: observations from the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) trial
Key result
In patients with atrial fibrillation treated with oral anticoagulants, obesity was associated with a lower risk of all-cause mortality compared with normal BMI (HR 0.63; 95% CI 0.54-0.74; P<0.0001).
Why the study?
Does higher BMI and waist circumference reduce mortality and cardiovascular events in atrial fibrillation patients treated with oral anticoagulation?
Population
17,913 patients with atrial fibrillation treated with oral anticoagulation from the ARISTOTLE trial
Comparison
Higher BMI and high waist circumference vs Normal BMI and normal waist circumference
Design
Cohort
Authors
Discussion
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Member takes
Implication
Supports obesity paradox in anticoagulated AF; leaves open whether BMI should alter OAC decisions or trial design.
Study Design
Type
Cohort (n=17,913)
Structured PICO
Does higher BMI and waist circumference reduce mortality and cardiovascular events in atrial fibrillation patients treated with oral anticoagulation?
P
Population
17,913 patients with atrial fibrillation treated with oral anticoagulation from the ARISTOTLE trial
I
Intervention
Higher BMI (overweight or obese) and high waist circumference (>102 cm for men, >88 cm for women)
C
Comparator
Normal BMI and normal waist circumference
O
Outcome
Stroke or systemic embolism, a composite endpoint (stroke, systemic embolism, myocardial infarction, or all-cause mortality), all-cause mortality, and major bleedingcomposite
Main Result
Effect estimate: HR 0.63 (95% CI 0.54-0.74)
p-value: p=< 0.0001
In patients with atrial fibrillation on oral anticoagulation, higher BMI and waist circumference are associated with a lower risk of mortality and cardiovascular events, supporting the existence of an 'obesity paradox'.
Cite This Study
Sandhu et al. (2016) conducted a cohort in Atrial fibrillation (n=17,913). Higher BMI (overweight or obese) and waist circumference vs. Normal BMI was evaluated on All-cause mortality (HR 0.63, 95% CI 0.54-0.74, p=< 0.0001). In patients with atrial fibrillation treated with oral anticoagulants, obesity was associated with a lower risk of all-cause mortality compared with normal BMI (HR 0.63; 95% CI 0.54-0.74; P<0.0001).