Key result
Weight loss and physical activity improve AF prognosis despite the obesity paradox.
Why the study?
Obesity and AF are increasing in epidemic proportions, and despite the demonstrated obesity paradox, the impact of lifestyle modifications on prognosis in obese patients with AF warrants discussion.
Does weight loss and physical activity improve prognosis in obese patients with atrial fibrillation despite the obesity paradox?
Does weight loss and physical activity improve prognosis in obese patients with atrial fibrillation despite the obesity paradox?
This review highlights that while an obesity paradox exists in atrial fibrillation, weight loss and exercise training still provide prognostic benefits for obese patients with AF.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Both obesity and atrial fibrillation have been increasing. So many people have both [conditions] already or just have high weight and are at very high risk of developing AF. What is especially scary is the fact that now 8% of adults in the US have [body mass index (BMI)] greater than or equal to 40, meaning severe or 'morbid' obesity.”
May support weight loss and exercise in obese AF; leaves open need for RCTs to guide practice.
Both obesity and atrial fibrillation (AF) are increasing in epidemic proportions, and both increase the prevalence of cardiovascular disease events. Obesity has adverse effects on cardiovascular hemodynamics and cardiac structure and function, and increases the prevalence of AF, partly related to electroanatomic remodeling in obese patients. However, numerous studies, including in AF, have demonstrated an obesity paradox, where overweight and obese patients with these disorders have a better prognosis than do leaner patients with the same degree of severity of cardiovascular disease/AF. In this paper, the authors discuss special issues regarding AF in obesity, as well as the evidence that despite the presence of an obesity paradox, there are benefits of weight loss, physical activity/exercise training, and increases in cardiorespiratory fitness on the prognosis of obese patients with AF.
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Lavie et al. (2017) conducted a review in Obesity and Atrial Fibrillation. Weight loss and physical activity was evaluated. Despite an obesity paradox where overweight and obese patients with atrial fibrillation have a better prognosis than leaner patients, weight loss and physical activity provide prognostic benefits.
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