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).
Cohort (n=17,913)
Does higher BMI and waist circumference reduce mortality and cardiovascular events in atrial fibrillation patients treated with oral anticoagulation?
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'.
Effect estimate: HR 0.63 (95% CI 0.54-0.74)
p-value: p=< 0.0001
AIMS: The prognostic implication of adiposity on clinical outcomes in atrial fibrillation (AF) patients treated with oral anticoagulation is unclear. METHODS AND RESULTS: ). Waist circumference (WC) was defined as high if >102 cm for men and >88 cm in women. Outcomes were stroke or systemic embolism, a composite endpoint (stroke, systemic embolism, myocardial infarction, or all-cause mortality), all-cause mortality, and major bleeding. Cox models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) across categories of BMI and WC adjusting for established risk factors and treatment allocation. At baseline, 4052 (22.6%) patients had a normal BMI, 6702 (37.4%) were overweight, and 7159 (40.0%) were obese. In multivariable analyses, higher BMI was associated with a lower risk of all-cause mortality overweight: HR 0.67 (95% CI 0.59-0.78); obese: HR 0.63 (95% CI 0.54-0.74), P < 0.0001 and the composite endpoint overweight: HR 0.74 (95% CI 0.65-0.84); obese: HR 0.68 (95% CI 0.60-0.78), P < 0.0001 compared with normal BMI. In women, high WC was associated with a 31% lower risk of all-cause mortality (P = 0.001), 27% lower risk of the composite endpoint (P = 0.001), and 28% lower risk of stroke or systemic embolism (P = 0.048) but not in men. There was no significant association between adiposity and major bleeding. CONCLUSION: In patients with AF treated with oral anticoagulants, higher BMI and WC are associated with a more favourable prognosis.
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).