Influence of obesity on outcomes in atrial fibrillation: yet another obesity paradox. Relation of Nonvalvular Atrial Fibrillation to Body Mass Index (from the SPORTIF Trials). Obesity and outcomes among patients with established atrial fibrillation. The long- and short-term impact of elevated body mass index on the risk of new atrial fibrillation the WHS (women's health study). Relationship between body mass index and left atrial appendage thrombus in nonvalvular atrial fibrillation Catheter Ablation for Atrial Fibrillation in Patients With Obesity Body mass index and adverse events in patients with incident atrial fibrillation. Overweight and obesity as risk factors for atrial fibrillation or flutter: the Danish Diet, Cancer, and Health Study. Cardiovascular risk in relation to body mass index and use of evidence-based preventive medications in patients with or at risk of atherothrombosis. Obesity, Brain Natriuretic Peptide Levels and Mortality in Patients Hospitalized With Heart Failure and Preserved Left Ventricular Systolic Function Physical Activity, Obesity, Weight Change, and Risk of Atrial Fibrillation: The Atherosclerosis Risk in Communities Study
BACKGROUND Obese patients have favorable outcomes in congestive heart failure , hypertension , peripheral vascular disease , and coronary artery disease . Obesity also has been linked with increased incidence of atrial fibrillation , but its influence on outcomes in atrial fibrillation patients has not been investigated . The objective of this research is to investigate the effect of obesity on outcomes in atrial fibrillation . METHODS The Atrial Fibrillation Follow-up Investigation of Rhythm Management ( AFFIRM ) study was one of the largest multicenter trials of atrial fibrillation , with 4060 patients . Subjects were r and omized to rate versus rhythm-control strategy . We performed a post hoc analysis of the National Heart , Lung and Blood Institute limited access data set of atrial fibrillation patients who had body mass index ( BMI ) data available in the AFFIRM study . BMI data were not available on 1542 patients . Patients with BMI > or=18.5 were split into normal ( 18.5 - 25 ) , overweight ( 25 - 30 ) , and obese ( > 30 ) categories as per BMI ( kg/m(2 ) ) . Multivariate Cox proportional hazards regression was used on the eligible 2492 patients . End points were all-cause mortality and cardiovascular mortality . RESULTS Over three fourths of all patients in our cohort were overweight or obese . There were 304 deaths ( 103 among normal weight , 108 among overweight , and 93 among obese ) and 148 cardiovascular deaths ( 54 among normal weight , 41 among overweight , and 53 among obese ) over a mean period of 3 years of patient follow-up . On multivariate analysis , overweight ( hazard ratio [ HR ] 0.64 ; 95 % confidence interval [ CI ] , 0.48 - 0.84 ; P=.001 ) and obese ( HR 0.80 ; 95 % CI , 0.68 - 0.93 ; P=.005 ) categories were associated with lower all-cause mortality as compared with normal weight . Overweight ( HR 0.40 ; 95 % CI , 0.26 - 0.60 ; P < .001 ) and obese patients ( HR 0.77 ; 95 % CI , 0.62 - 0.95 ; P=.01 ) also had lower cardiovascular mortality as compared with the normal weight patients . CONCLUSIONS Although in prior studies , obesity has been associated with increased risk of atrial fibrillation , an obesity paradox exists for outcomes in atrial fibrillation . Obese patients with atrial fibrillation appear to have better long-term outcomes than nonobese patients Obesity is well-established as a major cardiovascular ( CV ) risk factor . Obesity confers a greater risk for developing atrial fibrillation ( AF ) , but the relation between obesity and established nonvalvular AF for stroke and all-cause death is still unclear . To ascertain the prevalence of overweight and obesity in patients with nonvalvular AF , their influence on adverse events , and the relation with anticoagulation control , we performed this post hoc analysis of the pooled Stroke Prevention using an Oral Thrombin Inhibitor in patients with atrial Fibrillation ( SPORTIF ) III and V data sets . For this study , we analyzed all patients assigned to the warfarin arm with data on body mass index ( BMI ) . Time in therapeutic range was used as an index of the quality of anticoagulation control . The 3,630 patients eligible for this analysis were categorized as follows : ( 1 ) BMI 18.5 to 24.9 ( " normal weight " ) in 24.1 % ; ( 2 ) BMI 25.0 to 29.9 ( " overweight " ) in 39.8 % ; and BMI ≥30 ( " obese " ) in 36.1 % . Both overweight ( hazard ratio [ HR ] 0.70 ) and obese ( HR 0.59 ) categories were inversely associated with the composite outcome of stroke/all-cause death . A similar inverse association was seen for the end point of stroke ( HR 0.61 and 0.47 , respectively ) . Good anticoagulation control also attenuated the association between BMI categories and outcomes . In patients with time in therapeutic range > 70 % , BMI category was not significantly associated with the composite outcome of stroke/death and stroke . Stroke and all-cause death progressively reduced in overweight and obese anticoagulated patients with AF . The inverse relation of BMI categories to the risk of stroke and all-cause death was mitigated by good anticoagulation control Atrial fibrillation ( AF ) and obesity have reached epidemic proportions . The impact of obesity on clinical outcomes in patients with established AF is unknown . We analyzed 2,492 patients in the Atrial Fibrillation Follow-Up Investigation of Rhythm Management ( AFFIRM ) study .  Body mass index ( BMI ) was evaluated as a categorical variable ( normal 18.5 to < 25 kg/m(2 ) , overweight 25 to < 30 kg/m(2 ) , obese > or=30 kg/m(2 ) ) . Rate of death from any cause was higher in the normal BMI group ( 5.8 per 100 patient-years ) than in the overweight and obese groups ( 3.9 and 3.7 , respectively ) . Cardiovascular death rate was highest in the normal BMI group ( 3.1 per 100 patient-years ) , lowest in the overweight group ( 1.5 per 100 patient-years ) , and intermediate in the obese group ( 2.1 per 100 patient-years ) . After adjustment for baseline factors , differences in risk of death from any cause were no longer significant . However , overweight remained associated with a lower risk of cardiovascular death ( hazard ratio 0.47 , p = 0.002 ) . Obese patients were more likely to have an uncontrolled heart rate at rest , but rhythm-control strategy success was similar across BMI categories . In each BMI category , risk of death from any cause was similar for patients r and omized to a rhythm- or rate-control strategy . In conclusion , in patients with established AF , overweight and obesity do not adversely affect overall survival . Obesity does not appear to affect the relative benefit of a rate- or rhythm-control strategy OBJECTIVES The purpose of this study was to characterize the relationship between changes in  body mass index ( BMI ) and incident atrial fibrillation ( AF ) in a large cohort of women . BACKGROUND Obesity and AF are increasing public health problems . The importance of dynamic obesity-associated AF risk is uncertain , and mediators are not well characterized . METHODS Cases of AF were confirmed by medical record review in 34,309 participants in the Women 's Health Study . Baseline and up date d measures of  BMI  were obtained from periodic question naires . RESULTS During 12.9 + /- 1.9 years of follow-up , 834 AF events were confirmed . BMI was linearly associated with AF risk , with a 4.7 % ( 95 % confidence interval [ CI ] : 3.4 to 6.1 , p < 0.0001 ) increase in risk with each kilogram per square meter . Adjustment for inflammatory markers minimally attenuated this risk . When up date d measures of BMI were used to estimate dynamic risk , overweight ( hazard ratio [ HR ] : 1.22 ; 95 % CI : 1.02 to 1.45 , p = 0.03 ) , and obesity ( HR : 1.65 ; 95 % CI : 1.36 to 2.00 ; p < 0.0001 ) were associated with adjusted short-term increases in AF risk . Participants becoming obese during the first 60 months had a 41 % adjusted increase in risk of the development of AF ( p = 0.02 ) compared with those maintaining BMI < 30 kg/m(2 ) . The prevalence of overweight and obesity increased over time . The adjusted proportion of incident AF attributable to short-term elevations in BMI was substantial ( 18.3 % ) . CONCLUSIONS In this population of apparently healthy women , BMI was associated with short- and long-term increases in AF risk , accounting for a large proportion of incident AF independent of traditional risk factors . A strategy of weight control may reduce the increasing incidence of AF . ( Women 's Health Study [ WHS ] : A R and omized Trial of Low-Dose Aspirin and Vitamin E in the Primary Prevention of Cardiovascular Disease and Cancer ; NCT00000479 ) Atrial fibrillation and obesity are two major growing epidemics in the United States and globally . Obese people are at the increased risk of developing atrial fibrillation . The contribution of obesity as an independent risk factor for stroke in the setting of atrial fibrillation remains unclear . We tested the hypothesis that non-valvular atrial fibrillation ( NVAF ) patients with increased body mass index ( BMI ) would be at increased risk for the development of left atrial appendage thrombus ( LAAT ) .  Consecutive , anticoagulation naïve patients with NVAF referred for a transesophageal echocardiogram ( TEE ) between January 1 , 2007 and October 21 , 2009 were approached for study participation . All clinical , laboratory , and TEE measurement data were collected prospect ively . Within a group of 400 anticoagulation naïve NVAF patients ( mean age 63 ± 15 years , 28 % women ; 17 % with LAAT )  the prevalence of LAAT was similar across all BMI categories ( normal 13 % , overweight 19 % , obese 16 % , morbidly obese 16 % ; p = 0.71 ) . Despite a higher CHADS2 score and a higher prevalence of both hypertension and diabetes mellitus , elevated BMI was not an independent predictor of LAAT when analyzed as either a continuous variable , across BMI WHO categories , a dichotomous variable stratified at values above versus below 27 kg/m2 , or BMI stratified on atrial fibrillation duration . Despite a higher prevalence of major risk factors for thromboembolism , the prevalence of LAAT was not increased in overweight , obese , and morbidly obese patients Background — Obesity is a risk factor for atrial fibrillation and other cardiovascular conditions . Our objective was to determine whether catheter-based ablation effectively treated atrial fibrillation in obese patients . Methods and Results — Five hundred twenty-three consecutive patients with symptomatic , medication-refractory atrial fibrillation underwent catheter ablation .  Patients were grouped by body mass index ( lean , < 25 kg/m2 ; overweight , 25 to 29.9 kg/m2 ; obese , ≥30 kg/m2 ) . Outcome and quality of life were measured with a general health survey ( Medical Outcomes Study 36-item Short-Form General Health Survey [ SF-36 ] ) ; patients were assessed before ablation and at 3 and 12 months after the procedure . Two hundred twenty-eight study patients ( 44 % ) were overweight , and 201 ( 38 % ) were obese . Twelve months after curative ablation , 72 % of patients were free of atrial fibrillation without the use of antiarrhythmic agents ; 84 % were arrhythmia free when those receiving medication were included . Atrial fibrillation was eliminated in 75 % , 72 % , and 70 % of the lean , overweight , and obese patients , respectively , at 12 months ( P=0.41 , trend test ) . SF-36 scores were lower for patients with higher body mass index ( P<0.05 ) at baseline . SF-36 scores improved in every functional domain for all body mass index groups after ablation . The mean SF-36 total physical score increased from 59±20 at baseline to 77±19 in 12 months ( P<0.001 ) . The total mental health score improved from 66±18 to 79±16 in 12 months ( P<0.001 ) . Conclusions — Catheter ablation of atrial fibrillation was effective in obese patients . Coexistence of atrial fibrillation and obesity indicated lower SF-36 scores , but the improvement in quality of life was consistent across all body mass index categories BACKGROUND Obesity is associated with the development of atrial fibrillation and may impact atrial fibrillation-related outcomes . To date , no anthropometric measure is included in any risk stratification scheme for stroke and death in atrial fibrillation patients . METHODS The prospect i ve Danish Diet , Cancer and Health study is a cohort including 57,053 participants ( 27,178 men and 29,875 women ) aged between 50 and 64 years . The study population for this study included the 3135 patients ( 2025 men and 1110 women ) who developed incident atrial fibrillation during follow-up . RESULTS Of the subjects with atrial fibrillation , 1414 ( 45 % ) had a body mass index ( BMI ) in the overweight category ( BMI 25 to < 30 kg/m(2 ) ) and 767 ( 24 % ) were categorized as obese ( BMI ≥30 kg/m(2 ) ) . During a median follow-up of 4.9 years , 609 deaths and 216 thromboembolic events ( 98 % ischemic strokes ) occurred . Using normal-weight patients as reference , the risk of a composite end point of " ischemic stroke , thromboembolism , or death " was significantly higher in overweight ( crude hazard ratio [ HR ] 1.31 ; 95 % confidence interval [ CI ] , 1.09 - 1.56 ) and obese patients ( crude HR 1.55 ; 95 % CI 1.27 - 1.90 ) . After adjustment for CHADS2 and CHA2DS2-VASc scores , the HRs for the composite end point were 1.21 ( 95 % CI 1.02 - 1.45 ) and 1.31 ( 95 % CI 1.10 - 1.56 ) , respectively , for overweight and 1.25 ( 95 % CI 1.03 - 1.53 ) and 1.36 ( 95 % CI 1.11 - 1.65 ) , respectively , for obese . Continuous analyses of BMI stratified by sex identified obese men and normal-weight women as the sex-specific " high-risk " categories . CONCLUSION Overweight and obesity are risk factors for " ischemic stroke , thromboembolism or death " in patients with atrial fibrillation , even after adjustment for CHADS2 and CHA2DS2-VASc scores . The association between BMI and outcomes among atrial fibrillation patients may be modified by sex PURPOSE We examined the association between the body mass index analyzed as a continuous variable and by categorization according to World Health Organization criteria ( normal weight , overweight and obesity ) and the risk of a hospital ( inpatient as well as outpatient ) diagnosis of atrial fibrillation or flutter . METHODS Population -based prospect i ve cohort study conducted from December 1993 to December 2001 among 47589 participants ( 22482 men and 25107 women ) without preexisting cardiovascular or endocrine disease and with a mean age at baseline of 56 years ( range 50 - 64 years ) in the Danish Diet , Cancer , and Health Study . Subjects were followed up in the Danish National Registry of Patients and in the Danish Civil Registration System . RESULTS During follow-up ( mean , 5.7 years ) atrial fibrillation or flutter developed in 553 subjects ( 372 men and 181 women ) . The adjusted hazard ratio for atrial fibrillation or flutter per unit of increase in the body mass index was 1.08 ( 95 % confidence interval [ CI ] : 1.05 to 1.11 ) in men and 1.06 ( 95 % CI : 1.03 to 1.09 ) in women . When using normal weight as a reference , the adjusted hazard ratio for atrial fibrillation or flutter by overweight was 1.75 ( 95 % CI : 1.35 to 2.27 ) in men and 1.39 ( 95 % CI : 0.99 to 1.94 ) in women . The adjusted hazard ratio by obesity was 2.35 ( 95 % CI : 1.70 to 3.25 ) in men and 1.99 ( 95 % CI : 1.31 to 3.02 ) in women . CONCLUSION Overweight and obesity are associated with an increased risk of a diagnosis of atrial fibrillation or flutter AIM Explore the relation between body mass index ( BMI ) and cardiovascular disease , and the influence of optimal medical therapy ( OMT ) on this relationship . METHODS AND RESULTS Patients from the REACH cohort , an international , prospect i ve cohort of patients with or at high risk of atherosclerosis with documentation of potential confounders , including treatments and risk factors , were followed up to 4 years ( n = 54 285 ) . Patients were categorized according to baseline BMI ( ranging from underweight to Grade III obesity ) . Optimal medical therapy was defined as the use of the four cardioprotective medication classes ( statins , ACE inhibitors/angiotensin II receptor blockers , β-blockers , and antiplatelet agents ) . The main outcomes were all-cause mortality , cardiovascular ( CV ) mortality , and CV events . In primary and secondary prevention , a reverse J-shaped curve best described the relationship between BMI categories and the incidence of the various outcomes . In secondary prevention , the highest adjusted risks were observed for underweight patients ( 1.97 , P < 0.01 , and 1.29 , P = 0.03 , for CV mortality and CV events ) and the lowest HRs were observed , respectively , in Grade II and Grade III obese patients ( 0.73 , P < 0.01 and 0.80 , P < 0.01 ) . The proportion of patients on OMT increased with BMI from 10.1 to 36 % ( P < 0.001 ) . The apparent CV protection conferred by obesity persisted in patients receiving OMT . CONCLUSION An obesity paradox was observed in both primary and secondary CV prevention patients . The intensity of use of evidence -based preventive medications does not account for the paradoxical CV protection associated with obesity . At extremes of BMI , further interventions beyond OMT may be needed to reduce CV risk Background : An inverse relationship between brain natriuretic peptide ( BNP ) levels and body mass index ( BMI ) has been described for patients with left ventricular ( LV ) systolic dysfunction . In this study , the association of BMI , BNP levels and mortality in patients hospitalized for heart failure with preserved LV systolic function ( HFpLVF ) was investigated . Methods : One hundred fifty consecutive patients ( 98 % men ) who were hospitalized with HFpLVF and had BNP levels measured on admission were analyzed . Patients were divided into categories of BMI : normal ( BMI < 25 kg/m2 ) , overweight ( BMI 25–29.9 kg/m2 ) and obese ( BMI ≥ 30 kg/m2 ) . Relevant clinical and echocardiographic characteristics and all-cause mortality were obtained through chart review . Results : BNP levels were significantly lower in obese ( median = 227 pg/mL ) and overweight ( median = 396 pg/mL ) patients compared with those with normal BMI ( median = 608 pg/mL , P = 0.003 ) . Higher BMI predicted BNP levels of < 100 pg/mL. Compared with patients with normal BMI , overweight and obese patients had a significantly lower risk of total mortality , even after adjusting for other clinical characteristics , including log-transformed BNP levels , atrial fibrillation , the use of beta-blockers at discharge , age , hemoglobin levels and the presence of pulmonary congestion on admission . Higher BNP levels also independently predicted mortality . Conclusions : An inverse relationship between BMI and BNP levels exists in patients hospitalized with HFpLVF . Higher BMI is associated with lower mortality , whereas higher BNP levels predict higher mortality in male patients with HFpLVF . These findings should be confirmed in a larger multicenter setting Background —Physical activity ( PA ) has previously been suggested to attenuate the risk of atrial fibrillation ( AF ) conferred by excess body weight and weight gain . We prospect ively examined the relationship between body size , weight change , and level of PA in a biracial cohort of middle-aged men and women . Methods and Results —Baseline characteristics on risk factor levels were obtained on 14 219 participants from the Atherosclerosis Risk in Communities Study . AF incidence was ascertained from 1987 to 2009 . Adjusted Cox proportional hazards models were used to estimate the associations between body mass index , waist circumference , relative weight change , and PA level with incident AF . During follow-up , there were 1775 cases of incident AF . Body mass index and waist circumference were positively associated with AF as was weight loss/gain of > 5 % initial body weight . An ideal level of PA had a small protective effect on AF risk and partially attenuated the risk of AF associated with excess weight in men but not women : compared with men with a normal body mass index , the risk of AF in obese men with an ideal , intermediate , and poor level of PA at baseline was increased by 37 % , 129 % , and 156 % ( Pinteraction=0.04 ) . During follow-up , PA did not modify the association between weight gain and risk of AF . Conclusions —Obesity and extreme weight change are risk factors for incident AF , whereas being physically active is associated with a small reduction in risk . In men only , being physically active offset some , but not all , of the risk incurred with excess body weight
Results — An obesity paradox was found for cardiovascular death and all-cause death in the subgroup analyses of r and omized trial cohorts ; however , observational studies fail to show this relationship .
Conclusions — There may be an obesity paradox in atrial fibrillation patients , particularly for all-cause and cardiovascular death outcomes .
An obesity paradox was also evident for stroke/systemic embolic event outcome in NOAC trials , with a treatment effect favoring NOACs over warfarin for both efficacy and safety that was significant only for normal weight patients
Background and Purpose — Obesity is a risk factor for all-cause and cardiovascular death but , despite this , an inverse relationship between overweight or obesity and a better cardiovascular prognosis in long-term follow-up studies has been observed ; this phenomenon , described as obesity paradox , has also been found evident in atrial fibrillation cohorts .
Methods — We performed a systematic review on the relationship between body mass index and major adverse outcomes in atrial fibrillation patients .