Obesity Paradox In Patients Research Articles

Trends in Obesity and Risk of Cardiovascular Disease.

The obesity epidemic is a global health crisis of staggering proportion. Excess body weight is a major risk factor for the development of cardiovascular disease (CVD). We review temporal trends in obesity rates, pertinent pathophysiology to understand mechanisms of disease, and treatment strategies in the context of reducing cardiovascular risk. The prevalence of obesity is increasing in recent decades and is driven by a complex interplay of economic, environmental, and biological factors. In developed countries, changes in foodintake, such as increased consumption of energy-dense and added sugar have contributed significantly to weight gain. Single nucleotide variations in genes and alterations in the gut microbiome have been associated with the obese phenotype. The description of an obesity paradox in patients with CVD may have several explanations, including limitations of body mass index (BMI) to assess adiposity, selection bias, and lead-time bias with earlier onset of disease. Evidence-based treatments for weight loss include lifestyle intervention, pharmacotherapy, and bariatric surgery. Data on the long-term effects of these therapies on cardiovascular risk are limited. Overweight and obesity are associated with increased cardiovascular morbidity and mortality over the lifespan. Despite our increasing understanding of biological and environmental drivers of obesity, more work is needed in developing effective prevention strategies and implementation of evidence-based treatments to promote cardiovascular health and reduce cardiovascular risk. Ultimately, efforts to prevent and postpone cardiovascular morbidity should include focus on maintenance of normal BMI (primordial prevention) for a longer and healthier life, free of CVD.

Coronary Artery Disease and the Obesity Paradox in Patients with Type 2 Diabetes

Coronary Artery Disease and the Obesity Paradox in Patients with Type 2 Diabetes

Abstract TP338: The Obesity Paradox in Spontaneous Intracerebral Hemorrhage in the Nationwide Inpatient Sample

Introduction: Obesity is a well-established risk factor for cardiovascular disease and stroke. While a risk factor for the occurrence of these diseases, obesity has been shown to be unexpectedly protective in cardiac disease and ischemic stroke. Here we report the obesity paradox in patients with intracerebral hemorrhage (ICH) in the Nationwide Inpatient Sample (NIS). Methods: Clinical data for adult patients admitted for ICH were extracted from the Nationwide Inpatient Sample (NIS). Body habitus was classified as nonobese (body mass index [BMI] < 30 kg/m2), obese (BMI ≥ 30 kg/m2 and ≤ 40kg/m2), or morbidly obese (BMI>40kg/m2). Multivariable logistic regression analyzed the association of body habitus with in-hospital mortality rate, discharge disposition, extended length of stay, tracheostomy or placement of an endoscopic percutaneous gastrostomy, and ventriculoperitoneal shunt placement. Covariates included patient demographics, comorbidities, insurance status, occurrence of a craniotomy/craniectomy, and hospital characteristics. Cox proportional hazard regression also analyzed the effect of body habitus on in-hospital mortality. Results: In total, data from 61,324,882 patient discharges was screened from the NIS between 2007 to 2014. Of these, 99,212 patient discharges were 18 or older and admitted with atraumatic ICH as the primary diagnosis. In a multivariable logistic regression, both obese (0.67 [0.62, 0.76] p<.001) and morbidly-obese (0.85 [0.74, 0.97] p =0.02) patients were associated with decreased odds of in-hospital mortality as compared to those patients who were nonobese. This effect was not seen in other surrogate measures of outcome including non-routine discharge, extended hospitalization, tracheostomy/gastrostomy placement, and VP shunt placement. A Cox proportional hazards model also demonstrated that both obese (0.71 [-0.41, -0.26] p<.001) and morbidly obese (0.89 [-.021, -0.02] p<.001) patients had a significantly decreased risk of death during their hospital stay. Conclusion: Obesity appears to be associated with decreased inpatient mortality in spontaneous ICH in a large national dataset even when controlling for demographic and clinical course factors.

Obesity paradox in patients undergoing coronary intervention: A review

There is strong relationship exist between obesity and cardiovascular disease including coronary artery disease (CAD). However, better outcomes noted in obese patients undergoing percutaneous cardiovascular interventions for CAD, a phenomenon known as the obesity paradox. In this review, we performed extensive search for obesity paradox in obese patients undergoing percutaneous coronary intervention and discussed possible mechanism and disparities in different race and sex.

Obesity Paradox in Patients With Deep Venous Thrombosis.

We aimed to investigate the association between obesity and deep venous thrombosis (DVT) in a country with a high prevalence of obesity. This is a retrospective cohort study of patients who presented with DVT between 2008 and 2012. Data were analyzed and compared based on body mass index (BMI), and patients were classified into normal (<25), overweight (≥25 to <30), obese I (30 to <35), obese II (35 to <40), and obese III (≥40). Among 662 patients with DVT, 28% were overweight and 49% were obese. The mean age was 50.3 (16.5) years, and 51% were females. Diabetes mellitus and prior venous thromboembolism were significantly higher among obese patients. History of malignancy was more common in nonobese patients. Protein S and antithrombin III deficiency and hyperhomocysteinemia were more prevalent among morbid obese patients. Also, obese patients had higher incidence of thrombosis in the distal veins ( P = .03). Warfarin use and long-term therapy were more frequent in obese than nonobese. Postthrombotic syndrome was comparable in obese and nonobese groups. Recurrent DVT was higher in obese I ( P < .01), whereas mortality rates were greater in nonobese groups ( P = .001). Malignancy, diabetes mellitus, and common femoral vein involvement were predictors of mortality, whereas BMI ≥30 was the predictor of survival. Cox regression models showed that after adjusting for age, sex, pulmonary embolism, and duration of warfarin treatment, BMI ≥40 had better survival (hazard ratio: 0.177, 95% confidence interval: 0.045-0.691, P = .013). There is a significant association between obesity and DVT. Obese patients have characteristic risk factors and better survival. This obesity paradox needs further studies to assess its clinical and pharmacotherapeutic implications.

Evaluation of the impact of statin therapy on the obesity paradox in patients with acute myocardial infarction: A propensity score matching analysis from the Korea Acute Myocardial Infarction Registry.

The phenomenon of obesity paradox after acute myocardial infarction (AMI) has been reported under strong recommendation of statin therapy. However, the impact of statin therapy on this paradox has not been investigated. This study investigated the impact of statin therapy on 1-year mortality according to obesity after AMI. A total of 2745 AMI patients were included from the Korea Acute Myocardial Infarction Registry after 1:4 propensity score matching analysis (n = 549 for nonstatin group and n = 2196 for statin group). Primary and secondary outcomes were all-cause and cardiac death, respectively. During 1-year follow-up, the incidence of all-cause (8.4% vs 3.7%) and cardiac (6.2% vs 2.3%) death was higher in nonstatin group than in statin (P < .001, respectively). In nonstatin group, the incidence of all-cause (7.2% vs 9.0%) and cardiac (5.5% vs 6.5%) death did not differ significantly between obese and nonobese patients. However, in statin group, obese patients had lower 1-year rate of all-cause (1.7% vs 4.8%) and cardiac (1.2% vs 2.9%) death (P < .05, respectively), and lower cumulative rates by Kaplan-Meier analysis of all-cause and cardiac death compared with nonobese patients (log-rank P < .05, respectively). The overall risk of all-cause death was significantly lower in obese than in nonobese patients only in statin group (hazard ratio: 0.35; P = .001). After adjusting for confounding factors, obesity was independently associated with decreased risk of all-cause death in statin group. In conclusion, the greater benefit of statin therapy for survival in obese patients is further confirmation of the obesity paradox after AMI.

Effect of Heart Failure Secondary to Ischemic Cardiomyopathy on Body Weight and Blood Pressure

Both the obesity paradox and blood pressure (BP) paradox remain ill defined. Because both obesity and hypertension are well-known predictors of coronary artery disease (CAD) and acute heart failure (HF), in the present study, we compared the obesity paradox and the BP paradox between patients with acute HF with and without a history of CAD. A multicenter retrospective study was conducted on 3,204 consecutive patients with acute HF. Potential risk factors for in-hospital mortality were selected by univariate analyses; multivariate Cox regression analysis with backward stepwise selection was then used to identify significant factors. Kaplan-Meier survival curves and log-rank testing were used to compare in-hospital mortality between groups. Across the study cohort, 27% of patients had a history of CAD, and the all-cause in-hospital mortality rate was 5%. In-hospital mortality was significantly lower for patients with obesity than in those without obesity (log-rank, p = 0.033). However, this obesity paradox disappeared in the group with HF and CAD (log-rank, p = 0.740). In contrast, in-hospital mortality was significantly lower for patients with high BP at admission, regardless of the presence of a history of CAD (log-rank, p <0.001 for both groups). In conclusion, a history of CAD canceled the obesity paradox in patients with acute HF, whereas the BP paradox persisted regardless of a history of CAD.

Abstract TP341: Outcomes of Obese Patients With Intracerebral Hemorrhage

Introduction: Obesity is a known risk factor for cardiovascular disease and stroke. However, an obesity paradox - improved outcomes in obese patients, has been reported in coronary artery disease, cardiac surgery and ischemic stroke. We report a possible obesity paradox in patients with intracerebral hemorrhage (ICH). Methods: We retrospectively reviewed our prospectively collected database of patients diagnosed with ICH in our institution between November 2012 and March 2016. Trauma, malignancy, postoperative, vascular malformations associated hemorrhages and hemorrhagic conversion of ischemic strokes were excluded. Demographics, clinical, laboratory and imaging characteristics were collected. We defined obesity as body mass index (BMI) &gt;30kg/m 2 ; overweight 25-29.9kg/m 2 ; normal weight 18.5-24.9kg/m 2 and underweight &lt;18.5kg/m 2 . Poor outcome was defined by hematoma expansion &gt;30% increase in ICH volume or discharge to nursing home, long-term acute facility or death (‘poor-discharge’). Continuous variables were analyzed using an analysis of variance and a fisher exact test or chi-square test for categorical variables. A p value &lt;0.05 was set for significance. Results: 429 patients met criteria for our study. 50.1% were female, median age 64 years (SD 15.6) and BMI 27.4 (SD 7.9). There were 16 (3.7%) underweight; 131 (30.8%) normal weight; 138 (32.2%) overweight and 144 (33.6%) obese patients. Bivariate analysis across groups showed female gender (75% vs 56.5% vs 57% vs 50% p=0.015), diabetes mellitus (13.3% vs 20.6% vs 32.1% vs 33.3% p=0.041), systolic pressure (SBP) (177.5 vs 168 vs 175 vs 185 p=0.003), HbA1c (5.7 vs 5.9 vs 6.2 vs 6.5 p=0.0002), discharge poor outcome (43.8% vs 54.2% vs 55.8% vs 36.8% p=0.005) were significant. There was no difference in ICH volume and hematoma expansion. On multivariate analysis, only age (OR 1.02, CI 1.01 - 1.04 p=0.0004) SBP ≥ 140mmhg (OR 0.49, CI0.25 - 0.95, p=0.035) Admission glucose ≥180 (OR 2.71, CI 1.58 - 4.4.67 p=0.0003) and BMI &gt;30kg/m 2 (OR 0.5, CI 0.29 - 0.87 p= 0.014) remained independent predictors of poor outcome. Conclusion: In our cohort, obese patients were more likely to have a good outcome suggesting the presence of an obesity paradox in outcome following intracerebral hemorrhage.

MicroRNA-155 Deficiency Leads to Decreased Atherosclerosis, Increased White Adipose Tissue Obesity, and Non-alcoholic Fatty Liver Disease: A NOVEL MOUSE MODEL OF OBESITY PARADOX

Obesity paradox (OP) describes a widely observed clinical finding of improved cardiovascular fitness and survival in some overweight or obese patients. The molecular mechanisms underlying OP remain enigmatic partly due to a lack of animal models mirroring OP in patients. Using apolipoprotein E knock-out (apoE-/-) mice on a high fat (HF) diet as an atherosclerotic obesity model, we demonstrated 1) microRNA-155 (miRNA-155, miR-155) is significantly up-regulated in the aortas of apoE-/- mice, and miR-155 deficiency in apoE-/- mice inhibits atherosclerosis; 2) apoE-/-/miR-155-/- (double knock-out (DKO)) mice show HF diet-induced obesity, adipocyte hypertrophy, and present with non-alcoholic fatty liver disease; 3) DKO mice demonstrate HF diet-induced elevations of plasma leptin, resistin, fed-state and fasting insulin and increased expression of adipogenic transcription factors but lack glucose intolerance and insulin resistance. Our results are the first to present an OP model using DKO mice with features of decreased atherosclerosis, increased obesity, and non-alcoholic fatty liver disease. Our findings suggest the mechanistic role of reduced miR-155 expression in OP and present a new OP working model based on a single miRNA deficiency in diet-induced obese atherogenic mice. Furthermore, our results serve as a breakthrough in understanding the potential mechanism underlying OP and provide a new biomarker and novel therapeutic target for OP-related metabolic diseases.

Obesity and Other Cancers.

Purpose Evidence on overweight, obesity, and an increased risk of cancer continues to accumulate and was updated in the 2016 handbook on weight control from the International Agency for Research on Cancer (IARC). The underlying primary data, together with dose-response meta-analysis and, finally, pooled analysis of individual participant data, add insight into the relation between obesity and cancer risk and prognosis. We summarize the evidence for mortality from prostate cancer, hematologic malignancies, and kidney cancer. Methods We reviewed pooled analysis of rare end points across cohorts, regardless of primary results reported from the individual studies, further reducing risk of publication bias. Of these cancer sites, only kidney cancer was included in the IARC 2002 report, although mortality from prostate cancer and hematologic malignancies was noted in the American Cancer Society prospective cohort study in 2003. The 2016 update from the IARC added details for prostate and hematologic malignancies, classifying the evidence as sufficient to conclude that avoiding excess body fatness lowers the risk of multiple myeloma but found that the evidence for it lowering the risk of prostate cancer mortality or diffuse large B-cell lymphoma was limited. Results A higher body mass index is associated with an increased risk of advanced prostate cancer and prostate cancer mortality and is associated with worse survival in most subtypes of hematologic malignancies, in a dose-response fashion. Evidence for kidney cancer is built mostly on retrospective data, which supports an obesity paradox in patients with the clear cell variant; however, population-based cohort data indicate that a higher cohort-entry body mass index is associated with worse kidney cancer-specific survival. Conclusion Together, these data add support to the evidence for a growing cancer burden caused by adiposity in both early adult and later adult life, yet leave open the question of the means of weight management after diagnosis as a strategy to improve survival.

Association between the body mass index and the clinical findings in patients with acute heart failure: evaluation of the obesity paradox in patients with severely decompensated acute heart failure.

Obesity is known to be associated with the development of heart failure (HF). However, the relationship between the body mass index (BMI) and acute HF (AHF) remains to be elucidated. Eight hundred and eight AHF patients were enrolled in this study. The patients were assigned to four groups according to their BMI values: severely thin (n=11, BMI<16), normal/underweight (n=579, 16≤BMI<25), overweight (n=178, 25≤BMI<30) and obese (n=40, BMI≥30). The patients in the severely thin group were more likely to be female, have systolic blood pressure (SBP)<100mmHg and have valvular disease than normal/underweight patients. The patients in the overweight group were significantly younger than those in the normal/underweight, and those in the overweight group were more likely to have SBP≥140mmHg and hypertensive heart disease and less likely to have valvular disease than the patients in the normal/underweight group. The prognosis, including all-cause death, was significantly poorer among patients who were severely thin than those who were normal/underweight, overweight and significantly better among those who were overweight than those who were normal/underweight, severely thin and obese patients. A multivariate Cox regression model identified that severely thin [HR: 3.372, 95% confidence interval (CI) 1.362-8.351] and overweight (HR: 0.615, 95% CI 0.391-0.966) were independent predictors of 910-day mortality as the reference of normal/underweight. Overweight patients tended to have SBP≥140mmHg and be relatively young, while severely thin patients tended to have SBP<100 mmHg and be female. These factors were associated with a better prognosis of overweight patients and adverse outcomes in severely thin patients. These factors may contribute to the "obesity paradox" in severely decompensated AHF patients.

Obesity paradox in patients with community-acquired pneumonia: Is inflammation the missing link?

ObjectivePositive associations between body mass index (BMI) and clinical outcomes have been found and are called “the obesity survival paradox.” However, whether obesity has protective effects or if this paradox is because of confounding remains unclear. Herein, we analyzed the effects of weight on long-term mortality in a large cohort of patients with community-acquired pneumonia (CAP) and investigated whether the differential effects of obesity on inflammation pathways accounted for mortality differences. MethodsFor this secondary analysis, we followed prospectively for 6 y 763 CAP patients who were previously included in a multicenter trial (the ProHOSP Trial). To assess associations of BMI with mortality and with several inflammatory biomarker levels, we calculated three regression models adjusted for severity: the pneumonia severity index (PSI); fully adjusted for PSI, age, sex, metabolic factors, cardiovascular diseases, and other comorbidities; and fully adjusted including biomarker levels. ResultsWithin the 763 patients studied, all-cause 6-y mortality was significantly lower in obese patients (BMI >30 kg/m2) compared with normal-weight patients (BMI 18.5–25 kg/m2), with a severity-adjusted hazard ratio of 0.641 (95% confidence interval 0.462–0.889) and robust results in fully adjusted and fully adjusted plus biomarker models. No associations of increased BMI and C-reactive protein, procalcitonin, or white blood cell count were found, but BMI > 30 kg/m2 was associated with higher proadrenomedullin levels. ConclusionsOver a 6-y long-term follow-up, we found obesity to be associated with lower all-cause mortality in CAP patients, confirming the obesity paradox in this population. However, differences in inflammatory pathways did not explain these findings.

The obesity paradox in patients with severe soft tissue infections

BackgroundThe “obesity paradox” has been demonstrated in chronic diseases but not in acute surgery. We sought to determine whether obesity is associated with improved outcomes in patients with severe soft tissue infections (SSTIs). MethodsThe 2006 to 2010 Nationwide Inpatient Sample was used to identify adult patients with SSTIs. Patients were categorized into nonobese and obese (nonmorbid [body mass index 30 to 39.9] and morbid [body mass index ≥ 40]). Logistic regression provided risk-adjusted association between obesity categories and inhospital mortality. ResultsThere were 2,868 records with SSTI weighted to represent 14,080 patients. Obese patients were less likely to die in hospital than nonobese patients (odds ratio [OR] = .42; 95% confidence interval [CI], .25 to .70; P = .001). Subanalysis revealed a similar trend, with lower odds of mortality in nonmorbid obesity (OR = .46; 95% CI, .23 to .91; P = .025) and morbid obesity (OR = .39; 95% CI, .19 to .80; P = .011) groups. ConclusionsObesity is independently associated with reduced inhospital mortality in patients with SSTI regardless of the obesity classification. This suggests that the obesity paradox exists in this acute surgical population.

Obesity and Cardiovascular Disease.

The prevalence of obesity has increased worldwide over the past few decades. In 2013, the prevalence of obesity exceeded the 50% of the adult population in some countries from Oceania, North Africa, and Middle East. Lower but still alarmingly high prevalence was observed in North America (≈30%) and in Western Europe (≈20%). These figures are of serious concern because of the strong link between obesity and disease. In the present review, we summarize the current evidence on the relationship of obesity with cardiovascular disease (CVD), discussing how both the degree and the duration of obesity affect CVD. Although in the general population, obesity and, especially, severe obesity are consistently and strongly related with higher risk of CVD incidence and mortality, the one-size-fits-all approach should not be used with obesity. There are relevant factors largely affecting the CVD prognosis of obese individuals. In this context, we thoroughly discuss important concepts such as the fat-but-fit paradigm, the metabolically healthy but obese (MHO) phenotype and the obesity paradox in patients with CVD. About the MHO phenotype and its CVD prognosis, available data have provided mixed findings, what could be partially because of the adjustment or not for key confounders such as cardiorespiratory fitness, and to the lack of consensus on the MHO definition. In the present review, we propose a scientifically based harmonized definition of MHO, which will hopefully contribute to more comparable data in the future and a better understanding on the MHO subgroup and its CVD prognosis.

Exercise tolerance can explain the obesity paradox in patients with systolic heart failure: data from the MECKI Score Research Group

Obesity has been found to be protective in heart failure (HF), a finding leading to the concept of an obesity paradox. We hypothesized that a preserved cardiorespiratory fitness in obese HF patients may affect the relationship between survival and body mass index (BMI) and explain the obesity paradox in HF. A total of 4623 systolic HF patients (LVEF 31.5 ± 9.5%, BMI 26.2 ± 3.6 kg/m(2) ) were recruited and prospectively followed in 24 Italian HF centres belonging to the MECKI Score Research Group. Besides full clinical examination, patients underwent maximal cardiopulmonary exercise test at study enrolment. Median follow-up was 1113 (553-1803) days. The study population was divided according to BMI (<25, 25-30, >30 to ≤35 kg/m(2) ) and predicted peak oxygen consumption (peak VO2 , <50%, 50-80%, >80%). Study endpoints were all-cause and cardiovascular deaths including urgent cardiac transplant. All-cause and cardiovascular deaths occurred in 951 (28.6%, 57.4 per person-years) and 802 cases (17.4%, 48.4 per 1000 person-years), respectively. In the high BMI groups, several prognostic parameters presented better values [LVEF, peak VO2 , ventilation/carbon dioxide slope, renal function, and haemoglobin (P < 0.01)] compared with the lower BMI groups. Both BMI and peak VO2 were significant positive predictors of longer survival: both higher BMI and peak VO2 groups showed lower mortality (P < 0.001). At multivariable analysis and using a matching procedure (age, gender, LVEF, and peak VO2 ), the protective role of BMI disappeared. Exercise tolerance affects the relationship between BMI and survival. Cardiorespiratory fitness mitigates the obesity paradox observed in HF patients.

Obesity Paradox in Patients Hospitalized for Acute Ischemic Stroke: An Analysis of Nationwide Inpatient Sample Data (S47.008)

Obesity Paradox in Patients Hospitalized for Acute Ischemic Stroke: An Analysis of Nationwide Inpatient Sample Data (S47.008)

Cardiometabolic Disease Leading to Heart Failure: Better Fat and Fit Than Lean and Lazy.

High body mass index (BMI) and low cardiorespiratory fitness (CRF) are important modifiable risk factors for heart failure (HF). While the individual contributions of CRF and BMI toward risk for HF are well established, the interrelationship between BMI and CRF in modifying long-term HF risk is more complex and not well understood. In this review, we discuss and summarize the available evidence-base on individual and joint contributions of obesity and low CRF toward HF risk, including the potential mechanisms through which these lifestyle risk factors may lead to HF. We also discuss the role of interventions aimed at intentional loss of weight or CRF improvement as potential HF preventive strategies. Finally, the article also highlights the modifying effects of CRF on survival in relation to the obesity paradox in patients with established HF.

Abstract 105: Obesity Paradox in Patients with Non-Hemorrhagic Stroke: Increased Short-Term Survival with Decreased Longevity

Background: Obesity is associated with improved outcomes in patients with congestive heart failure and/or coronary artery disease; the obesity paradox. Effects of obesity on mortality in non-hemorrhagic stroke patients have not been well investigated. Material and Methods: Retrospective chart review was performed in 146 consecutive patients treated for non-hemorrhagic stroke at a single academic medical center. Patients were divided in to 4 groups according to their BMI: Group I with BMI (0-18.5 kg/m 2 )-4 patients (3%) Group II BMI (18.6-25 kg/m 2 )-51 patients (35%), Group III BMI (26-30 kg/m 2 )-46 patients (32%), and Group IV BMI (31+)-45 patients (31%). Long-term outcomes were ascertained through the National Death Index. This study was approved by the institutional IRB. Results: Prevalence of CAD, female gender, hypertension, atrial fibrillation, hyperlipidemia, PVD and chronic kidney disease were similar between BMI groups. Overweight patients with non-hemorrhagic stroke were younger, with an increased incidence of diabetes (4% in Group II, 25% in Group III, and 37% in Group IV, p&lt;0.0016). There was a trend of increased prevalence of hypertension in overweight patients with non-hemorrhagic stroke (51% in Group II, 55% in Group III, and 70% in Group IV, p=0.3146). Lower BMI was associated with increased short-term mortality (52% in Group II, 33% in Group III and 12% in Group IV, p &lt;0.004). Despite improved short term mortality, the overall longevity in obese stroke patients were significantly reduced, as compared to patients with normal weight. Average age at time of death was 86+/- 9.6 years old in Group II patients, 76 +/- 15 years old in Group III, and 76 +/- 9.8 years old in Group IV patients, p&lt;0.003 for Group III vs. II and p&lt;0.001 in Group IV vs. II) Conclusions: Obese patients present with non-hemorrhagic stroke at a younger age. Despite short term improved outcomes, obesity is not associated with improved overall longevity.

Does the influence of obesity on prognosis differ in men and women? A study of obesity paradox in patients with acute coronary syndrome.

Recent studies have reported the existence of obesity paradox in acute coronary syndromes (ACS). However, the occurrence of obesity paradox in men and women has not yet been thoroughly investigated, even though both genders differ in patterns and incidence of obesity. Therefore, the aim of this study was to investigate whether obesity influence on outcomes of patients with ACS varies by gender. This retrospective study included 341 patients admitted to hospital for treatment due to ACS in 2012. They were classified according to the World Health Organisation with use of body mass index (BMI) as normal weight, overweight, and obese. All patients received standard discharge medication. All-cause mortality was assessed during a mean follow-up time of 212 ± 121 days. There were 82 (24%) normal weight, 160 (47%) overweight, and 99 (29%) obese patients. There were 252 (73.9%) men. All-cause mortality was lower in the obese and overweight vs. normal weight male patients (1.4% vs. 3.3% vs. 13.1%, respectively, p = 0.009). There was a trend favouring the normal weight and obese vs. overweight women (4.8% vs. 3.6% vs. 17.5%, respectively, p = 0.103). In the general population, after adjustment, BMI increase by one reduced risk by 15.6% (p = 0.015), and obesity reduced risk by 50.8% (p = 0.056). Obesity reduced risk for men by 69.4% (p = 0.015), and BMI increase by one reduced risk for men by 22% (p = 0.002). BMI and obesity were independent prognostic factors in men, whereas no such phenomenon was observed in women. Only male patients seem to contribute to the obesity paradox observed in patients with ACS. The obesity paradox does not occur in female patients when considered separately. Obesity seems to have a different influence on outcomes in both genders, and this might be worthy of further studies.

The obesity paradox in patients undergoing transcatheter aortic valve implantation.

Obesity is a major risk factor for cardiovascular morbidity and mortality. A considerable number of studies, however, showed better outcomes for overweight patients undergoing cardiovascular interventions-the so called obesity paradox. Increased body mass index (BMI) is independently associated with improved survival following transcatheter aortic valve implantation (TAVI). We analyzed the data of 409 consecutive patients undergoing TAVI in our medical center. Patients were categorized into 4 groups according to BMI: underweight (≤18.4 kg/m(2) ), normal weight (18.5-24.9 kg/m(2) ), overweight (25-29.9 kg/m(2) ), and obese (≥30 kg/m(2) ). Procedure-related complications were recorded, as well as 30-day and 1-year all-cause mortality rates. Obese patients had a higher prevalence of comorbidities and higher incidence of vascular complications compared with the normal-weight patients (16% vs 7%, P = 0.013). Nevertheless, 30-day mortality was similar among the groups, whereas 1-year mortality was lower among the overweight and obese patients (BMI >25) (P = 0.038). After adjusting for differences in baseline characteristics, increase in BMI was found to be independently associated with improved survival following TAVI (hazard ratio: 0.94, confidence interval: 0.89-0.99, P = 0.043). In our single-center study, obesity and overweight were independently associated with better outcome, supporting the obesity paradox in the TAVI population.