Key result
Obesity is linked to ~21% lower mortality in combined pre- and post-capillary pulmonary hypertension.
Why the study?
Data on the reported obesity paradox in pulmonary hypertension are conflicting, with some studies demonstrating decreased mortality while others found no effect of obesity on mortality.
Does obesity reduce mortality in patients with pulmonary hypertension?
Meta-Analysis (n=13,987)
Yes
Does obesity reduce mortality in patients with pulmonary hypertension?
Hazard Ratio: 0.79 (95% CI 0.66–0.95)
p-value: p=0.01
An 'obesity paradox' is observed in pulmonary hypertension where obesity is associated with reduced mortality, though this may reflect confounding from right ventricular failure-induced cachexia rather than a true protective effect of adiposity.
Supports obesity paradox in pulmonary hypertension; should not change practice and leaves open confounding by cachexia.
Obesity is reported to have a protective effect on mortality in pulmonary hypertension (PH), a phenomenon known as obesity paradox. However, the data are conflicting, with some studies showing decreased mortality while other studies found no effect of obesity on mortality. Therefore, we performed a systematic review and meta-analysis to examine whether there is an association between obesity and mortality in PH. Only patients with PH diagnosed by right heart catheterization were included. We also performed a sub-group analysis of subjects with pre-capillary PH only. A total of six studies met the inclusion criteria, with a sample size of 13,987 patients. Obese subjects had lower mortality compared to non-obese subjects in the combined pre- and post-capillary PH group (hazard ratio 0.79, 95% CI 0.66–0.95, p = 0.01). While obesity was associated with reduction in mortality in the pre-capillary PH group (hazard ratio 0.77, 95% CI 0.60 to 0.98, p = 0.03), this was not uniform across all studies.
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Reddy et al. (2023) conducted a meta-analysis in Pulmonary Hypertension (n=13,987). Obesity (BMI ≥ 30 kg/m²) vs. Non-obese (BMI < 30 kg/m²) or normal weight (BMI 18.5-24.9 kg/m²) was evaluated on Mortality (HR 0.79, 95% CI 0.66-0.95, p=0.01). Obesity was associated with a significant reduction in mortality compared to non-obese subjects in the combined pre- and post-capillary pulmonary hypertension group (HR 0.79).
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