Body Mass Index Categories In Patients Research Articles

P591 Negative impact of high body mass index on the efficacy of anti-TNFα agents in patients with Inflammatory Bowel Disease

Abstract Background Anti-tumor necrosis factor (TNF)-α agents are a therapy of choice in the induction and maintenance treatment of inflammatory bowel disease (IBD). Unfortunately, their efficacy varies. Some IBD patients are primary non-responders and many will experience a secondary loss of response. However, we do not yet have good predictors of their efficacy. Obesity, which prevalence increases worldwide, is also increasingly found in IBD population. Some studies suggest an association between obesity and poorer response to anti-TNFα therapy in IBD patients, although with conflicting results. The aim of this study is to assess the impact of patients’ body mass index (BMI) on the efficacy of anti-TNFα agents in IBD and if there is difference according to the route of administration (intravenous (IV) vs subcutaneous (SC)) or the type of disease (Crohn’s disease (CD) vs ulcerative colitis (UC)). Methods We retrospectively collected data from 188 patients with IBD, aged ≥ 18 years, treated with a first anti-TNFα agent started in our center between January 2002 and December 2020 to avoid missing data. A lack or loss of response to anti-TNFα therapy was defined by the need to optimize or change the treatment or by the initiation of any intercurrent treatment (steroid therapy, hospitalization, or surgery). Frequency of the event and time to its occurrence were analyzed and compared according to BMI using uni- and multivariate logistic regression models and survival curves (Kaplan-Meier), represented by BMI categories (<18.5; 18.5-25; 25-30 and ≥ 30 kg/m²). Results In this cohort of 188 patients (143 CD, 43 UC, 2 Indeterminate Colitis), 8% were obese. We observed that the higher the patient’s BMI, the earlier the risk of optimization or change of treatment (HR=1.043, p=0.045). Association was even stronger for obese patients (HR=2.13, p=0.018). After adjustment for IBD type and administration route, association with obesity persisted. Two other characteristics - female gender (HR=1.56, p=0.012) and higher CRP (HR=1.14, p=0.021) – were associated with earlier optimization or treatment change. Similarly, analysis of survival curves showed a significant difference in time to optimization or change of treatment between BMI categories in patients with CD (p=0.02) but not in those with UC (p=0.87). No association was found between BMI and need for intercurrent treatment. Conclusion This study confirms an association between higher BMI – specifically obesity - and an earlier loss of efficacy of a first anti-TNFα treatment, regardless of IBD type or route of drug administration. Prospective studies with analysis of trough levels are required for a better understanding of the mechanisms involved in the response to anti-TNFα therapy in IBD obese patient.

Rivaroxaban Monotherapy in AtrialFibrillation and Stable Coronary Artery Disease Across Body Mass IndexCategories.

The AFIRE (Atrial Fibrillation and Ischemic Events With Rivaroxaban in Patients With Stable Coronary Artery Disease) trial showed both noninferiority for efficacy and superiority for safety endpoints of rivaroxaban monotherapy compared with those of rivaroxaban plus antiplatelet therapy (combination therapy) in patients with atrial fibrillation and stable coronary artery disease. This study sought to evaluate outcomes of rivaroxaban monotherapy in those patients across body mass index (BMI) categories. Patients were categorized into 4 groups: underweight (BMI<18.5kg/m2), normal weight (BMI 18.5 to<25kg/m2), overweight (BMI 25 to<30kg/m2), and obesity (BMI≥30kg/m2). Efficacy (a composite of all-cause death, myocardial infarction, unstable angina requiring revascularization, stroke, or systemic embolism) and safety (major bleeding defined according to International Society on Thrombosis and Haemostasis criteria) were compared between rivaroxaban monotherapy and combination therapy across BMI categories. This study analyzed 2,054 patients with a median age of 75.0 years and CHA2DS2-VASc score of 4. A significant interaction was not observed between BMI categories and effect of monotherapy for efficacy (P=0.83) and safety (P = 0.07), although monotherapy was superior to combination therapy for efficacy in normal weight (HR: 0.64; 95%CI: 0.44-0.95) and safety in overweight (HR: 0.25; 95%CI: 0.10-0.62), whereas a significant difference in the endpoints was not observed in the other BMI categories. Rivaroxaban monotherapy had a similar effect on prognosis across all BMI categories in patients with atrial fibrillation and stable coronary artery disease. (Atrial Fibrillation and Ischemic Events With Rivaroxaban in Patients With Stable Coronary Artery Disease [AFIRE]; UMIN000016612, NCT02642419).

Effect of rivaroxaban monotherapy vs. combination with anti-platelet therapy in patients with atrial fibrillation and stable coronary artery disease across different body mass index categories

Abstract Background The AFIRE (Atrial Fibrillation and Ischemic Events With Rivaroxaban in Patients With Stable Coronary Artery Disease) trial showed both noninferiority for efficacy and superiority for safety endpoints of rivaroxaban monotherapy compared to rivaroxaban plus antiplatelet therapy (combination therapy) in patients with atrial fibrillation (AF) and stable coronary artery disease (CAD). However, no accumulating evidence regarding efficacy and safety of these fixed-dose direct oral anticoagulant therapy was available in underweight and obese patients. Purpose The aim of this post-hoc analysis of the AFIRE trial was to evaluate outcomes of rivaroxaban monotherapy (vs. combination therapy) in patients with AF and stable CAD across body mass index (BMI) categories. Methods Patients were categorized into groups 1 (underweight: BMI of &amp;lt;18.5 kg/m2), 2 (normal: BMI of 18.5 to &amp;lt;25 kg/m2), 3 (overweight: BMI of 25 to &amp;lt;30 kg/m2), and 4 (obesity: BMI of ≥30 kg/m2). Efficacy (a composite of all-cause death, myocardial infarction, unstable angina requiring revascularization, stroke, or systemic embolism) and safety (major bleeding defined according to International Society on Thrombosis and Haemostasis criteria) were compared between rivaroxaban monotherapy and combination therapy across BMI categories. Results We analyzed 2,054 patients with a median age of 75.0 (interquartile range [IQR], 69 to 80)) years old and CHA2DS2-VASc of 4 (IQR, 3 to 5). Group 1 through 4 included 72 (3.5%), 1,158 (56.4%), 680 (33.1%), 144 (7.0%) patients and 62.3%, 52.3%, 36.2%, and 30.3% were received reduced dose of rivaroxaban, respectively. Although the sample sizes for group 1 and 4 were limited, monotherapy was superior to combination therapy for efficacy in group 2 (hazard ratio [HR], 0.64; 95% CI, 0.44 to 0.95) and safety in group 3 (HR, 0.25; 95% CI, 0.10 to 0.62), whereas a significant difference in the endpoints was not observed in the other BMI categories. Impact of monotherapy on endpoints did not have a significant interaction in BMI. Conclusions Rivaroxaban monotherapy had similar effect on prognosis across all BMI categories in patients with AF and stable CAD. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): The Japan Cardiovascular Research Foundation based on a contract with Bayer Yakuhin, Ltd

Impact of Patient BMI on Patient and Operator Radiation Dose During Percutaneous Coronary Intervention

This study sought to investigate patient and operator radiation dose in patients undergoing percutaneous coronary intervention (PCI) and the impact of body mass index (BMI) on patient and operator dose. In patients undergoing PCI, radiation dose parameters, baseline characteristics and procedural data were collected in a tertiary centre for 3.5 years. Operators wore real time dosimeters. Patients were grouped by BMI. Dose area product (DAP) and operator radiation dose were compared across patient BMI categories. Multivariable analysis was performed to investigate the impact of patient BMI and other procedural variables on patient and operator dose. 2,043 patients underwent 2,197 PCI procedures. Each five-unit increase in BMI increased patient dose (expressed as DAP) by an average 31% (95% CI: 29-33%) and operator dose by 27% (95% CI: 20-33%). Patient dose was 2.3 times higher and operator dose was 2.4 times higher in patients with a BMI>40 than for normal BMI patients. Multivariable analysis indicated that there were many procedural factors that were predictors for increasing operator dose and patient dose but that patient BMI was a major contributor for both operator dose and patient dose. Increasing BMI increases the DAP and operator dose for PCI procedures and BMI is demonstrated to be a major factor that contributes to both patient and operator radiation dose.

Abstract P003: Effectiveness And Safety Of Direct Oral Anticoagulants Compared With Warfarin In Patients With Atrial Fibrillation Across Body Mass Index Categories

Background: Although direct oral anticoagulants (DOACs) are preferred for most patients needing anticoagulation for atrial fibrillation (AF), uncertainty remains in the effectiveness and safety of DOACs compared with warfarin in patients with obesity. Available data from large real-word cohorts are lacking. Purpose: To examine the effectiveness and safety of DOACs compared with warfarin in patients with obesity and AF. Methods: We conducted a retrospective cohort study at an integrated, multi-site healthcare system. We included patients with AF prescribed either a DOAC or warfarin with ≥ one year of follow-up between 2010-2017. The primary effectiveness outcome was ischemic stroke or systemic embolism (S/SE) and the primary safety outcome was incident intracranial hemorrhage (ICH). Using logistic regression, we calculated propensity scores (PS) of prescription for DOAC in each body mass index (BMI) category (&lt;25 kg/m2, 25.0-29.9 kg/m2, 30.0 to 34.9 kg/m2, and BMI≥35.0 kg/m2) using the following covariates: age, sex, race, ethnicity, BMI, systolic blood pressure, and CHA 2 DS 2 -VASc score. We used inverse probability weighting (IPW) based on the PS and IPW-weighted hazard ratios with 95% confidence intervals were calculated by Cox proportional hazard model. Results: Of a total of 17,905 patients included, mean (standard deviation [SD]) age was 70 ± 12 years and mean (SD) BMI was 29.9 ± 6.7 kg/m 2 ; nearly half received a prescription for DOAC (42.7%) and 57.3% for warfarin. During median follow-up of 3.8 years (interquartile range: 2.2-6.0), a total of 159 stroke and 376 intracranial hemorrhage events were observed. Patients on DOACs had a similar or lower HRs for both S/SE and ICH events compared with warfarin across each BMI category (Figure). Conclusion: In this retrospective study, DOACs were as safe and effective compared with warfarin across BMI categories in patients with AF.

Patient Body Mass Index and Occupational Radiation Doses to Circulating Nurses During Coronary Angiography

BackgroundPatient BMI is associated with radiation doses received by interventional cardiologists, yet the association between patient BMI and nurse radiation doses is unknown. This study evaluated the association between patient body mass index (BMI) and nurse radiation doses during coronary angiography. MethodsNurse radiation doses were collected by real-time dosimeters during consecutive coronary angiography procedures and are reported as the personal dose equivalent (Hp10). Patient radiation doses were estimated using dose area product (DAP). Patient BMI was categorized in kg/m2 as <25.0, 25.0–29.9, 30.0–34.9, 35.0–39.9, and ≥40. Multiple regression analysis determined procedural factors independently association with nurse radiation doses. ResultsIn 643 consecutive coronary angiography procedures, patient radiation doses increased significantly across increasing patient BMI categories (p < 0.001). Compared to a patient BMI <25, a patient BMI ≥40 was associated with a 2.3-fold increase in DAP (p < 0.001). Significant differences were also observed in nurse radiation doses across patient BMI categories (p = 0.036). Compared to a patient BMI <25, a patient BMI ≥40 was associated with a 4.0-fold increase in nurse radiation dose (BMI < 25: 0.3 [0.1, 1.3] μSv; BMI ≥ 40: 1.2 [0.2, 2.9] μSv; p = 0.003). By multiple regression analysis, each 1-unit kg/m2 increase in patient BMI was associated with a 3.3% increase in nurse radiation dose (p = 0.002). ConclusionsPatient BMI was significantly associated with nurse radiation doses during coronary angiography. These observations may have important implications on nurse radiation safety, especially in the setting of the ongoing obesity epidemic.

PUK21 INCIDENCE OF SEVERE CHRONIC KIDNEY DISEASE AND COMORBIDITY AND CLINICAL PROFILES BY BODY MASS INDEX: A REAL-WORLD ANALYSIS USING CLAIMS AND ELECTRONIC HEALTH RECORDS

Describe incidence of severe chronic kidney disease (CKD) and comorbidity profiles by patient body mass index (BMI) using real-world claims and electronic health records (EHR) database. Adults age ≥18 newly diagnosed with severe CKD (stage 4, 5, and end stage) between 6/30/2007 and 6/3/2017 were identified in the IBM® MarketScan® Explorys® Claims-EHR Data Set, which includes detailed medical and pharmacy claims data and clinical information in patient health records. Incidence of severe CKD were stratified by BMI measured during 1-year prior to CKD diagnosis (index event). The following BMI categories were used (kg/m2): Underweight <18.5, normal weight 18.5 to 24.9, overweight 25 to 29.9, obese 30 to 39.9, morbidly obese ≥ 40. Comorbid conditions and hemoglobin A1C (HbA1c) level during the 1-year pre-index were stratified by BMI. Patients with evidence of pregnancy or primary cancers were excluded. 7,724 patients were newly diagnosed with severe CKD, with 2% underweight, 22% normal weight, 30% overweight, 36% obese, and 10% morbidly obese (Mean age 71; 52% male). Prevalent of comorbid conditions increasing from underweight to morbidly obese categories were type 2 diabetes (T2DM) from 28% to 77%, dyslipidemia 45% to 68%, hypertension 80% to 92%, and congestive heart failure 38% to 47%. Depression (18-19%), COPD (36-37%), and pain (77-78%) were similar between underweight and morbidly obese categories but higher than normal (16%, 29%, 71%), overweight (13%, 27%, 70%) and obese (14%, 29%, 72%). Among a subset with HbA1c results, the mean HbA1c increased from 6.7 in normal weight to 7.2 in morbidly obese categories. While incidence of severe CKD diagnosis were higher in obese patients, patient BMI categories revealed different comorbidity profiles. Prevalence of T2DB and other metabolic syndrome conditions increased with BMI, while other conditions were highest among patients at the opposite ends of BMI spectrum.

Serum Calcium Levels in Chronic Kidney Disease Patient Stratified By Body Mass Index

Background : Most of the chronic kidney disease (CKD) patients have low blood calcium levels, yet hypercalcemia has a worse outcome in CKD patients. Interestingly, CKD patients with higher body mass index (BMI) have better outcomes. This study aimed to elucidate the difference in blood calcium levels stratified by BMI categories in patients with CKD. Methods : The study was conducted using a comparative analytical cross-sectional study design. Patients with CKD (n100), aged over 18 years old were included, Patients with the following were excluded: the history of hemodialysis, history of antioxidants, calcium and vitamin D supplement consumption, history of infection and malignancy. BMI of patients was categorized into underweight (<18.5 kg/m2), normal (8.5-22.9 kg/m2), and overweight or obese (≥23 kg/m2). Data were analyzed to compare blood calcium in different categories of BMI (Kruskal-Wallis test). Results: The age of patients with CKD included in this study had median age of 61 years old, predominantly was men (57%). The blood calcium level of CKD patients was on the lower border of the normal range. Median BMI was 23.48 kg/m2, of which 53% was categorized as overweight or obese. There was a trend that overweight/obese patients had higher blood calcium levels than underweight and normal-weight patients, however, no statistically significant difference between the BMI category (p=0.982). Conclusions : The blood calcium level in chronic kidney disease varies across the BMI category, however, no correlation with the BMI.

From the Circulation Family of Journals.

From the Circulation Family of Journals.

TCT-557 Impact of a Suspended Lead Suit on Physician Radiation Doses Across Patient BMI Categories During Coronary Angiography

Increasing patient body mass index (BMI) results in greater scatter radiation and leads to increased physician radiation exposure during coronary angiography. It is unknown if use of a suspended lead suit rather than standard lead garments can offset the increased physician radiation doses typically

Impact of patient obesity on radiation doses received by scrub technologists during coronary angiography.

The impact of patient obesity on scrub technologist radiation dose during coronary angiography has not been adequately studied. Real-time radiation exposure data were prospectively collected during consecutive coronary angiography cases. Patient radiation dose was estimated by dose area product (DAP). Technologist radiation dose was recorded by a dosimeter as the personal dose equivalent (Hp (10)). Patients were categorized according to their body mass index (BMI): <25.0, lean; 25.0-29.9, overweight; ≥30.0, obese. The study had two phases: in Phase I (N = 351) standard radiation protection measures were used; and in Phase II (N = 268) standard radiation protection measures were combined with an accessory lead shield placed between the technologist and patient. In 619 consecutive coronary angiography procedures, significant increases in patient and technologist radiation doses were observed across increasing patient BMI categories (p < 0.001 for both). Compared to lean patients, patient obesity was associated with a 1.7-fold increase in DAP (73.0 [52.7, 127.5] mGy × cm2 vs 43.6 [25.1, 65.7] mGy × cm2, p < 0.001) and a 1.8-fold increase in technologist radiation dose (1.1 [0.3, 2.7] μSv vs 0.6 [0.1, 1.6] μSv, p < 0.001). Compared to Phase I, use of an accessory lead shield in Phase II was associated with a 62.5% reduction in technologist radiation dose when used in obese patients (p < 0.001). During coronary angiography procedures, patient obesity was associated with a significant increase in scrub technologist radiation dose. This increase in technologist radiation dose in obese patients may be mitigated by use of an accessory lead shield.

Metal or Modularity: Why Do Metal-Backed Tibias Have Inferior Outcomes to All-Polyethylene Tibial Components in Patients With Osteoarthritis

BackgroundBiomechanical studies have suggested improved stress distribution in metal-backed (MB) compared to all-polyethylene (AP) tibias, but such potential benefits have not been realized clinically. The purpose of this investigation was to analyze the outcomes of AP components in patients with primary osteoarthritis and compare the results to those obtained with MB tibial components in total knee arthroplasty (TKA). MethodsWe reviewed 11,653 patients undergoing primary TKA for osteoarthritis. There were 9999 (86%) MB (8470 modular and 1529 monoblock) and 1654 (14%) AP tibial components. All patients had at least 2 years of clinical follow-up with mean follow-up of 8 years (range, 2-30 years). ResultsMean survivorship for all primary TKAs at the 5-year, 10-year, 15-year, and 20-year time points was 97%, 92%, 86%, and 78%. AP tibial components were found to have improved survivorship when compared to modular and monoblock MB counterparts (P < .0001). Likewise, AP tibial components were found to have lower rates of tibial component loosening (P < .0001), tibial osteolysis, and component fracture. Furthermore, the AP group had improved survival rates in most age-groups except <55 years where there was no difference. AP tibial components demonstrated improved survival for all body mass index (BMI) groups except in patients with a BMI ≤25 kg/m2 where there was no difference. ConclusionAP tibial components had significantly improved implant survival across all age-groups and most BMI categories in patients who underwent TKA for osteoarthritis. Given these outcomes, AP tibias are a reasonable option, regardless of patient age and BMI.