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- Title
The obesity paradox: association of obesity with improved survival in medically managed severe aortic stenosis.
- Authors
Jinghao Nicholas Ngiam; Chew, Nicholas W. S.; Yong-Qiang Tan, Benjamin; Hui Wen Sim; Ching-Hui Sia; Kong, William K. F.; Tiong-Cheng Yeo; Kian-Keong Poh; Ngiam, Jinghao Nicholas; Chew, Nicholas Ws; Tan, Benjamin Yong-Qiang; Sim, Hui Wen; Sia, Ching-Hui; Kong, William KF; Yeo, Tiong-Cheng; Poh, Kian-Keong
- Abstract
<bold>Introduction: </bold>The obesity paradox, where obesity is associated with improved survival, has been described in patients undergoing haemodialysis and in heart failure. It was also demonstrated in patients undergoing valve replacement for aortic stenosis (AS). We explored this phenomenon in medically managed severe AS.<bold>Methods: </bold>154 patients with medically managed severe AS (aortic valve area index [AVAi] < 0.6 cm2/m2; mean pressure gradient > 40 mmHg and peak velocity > 400 cm/s) and preserved left ventricular ejection fraction (> 50%) were categorised into the obese (body mass index [BMI] Asian cut-off ≥ 27.5 kg/m2) and non-obese groups. Their clinical and echocardiographic profiles were compared.<bold>Results: </bold>24 (15.6%) patients were obese. Obese patients were similar to non-obese patients in age (68.5 ± 11.6 vs. 68.9 ± 13.1 years) but had higher prevalence of cardiovascular risk factors. Left atrial diameter (43.7 ± 6.7 vs. 38.5 ± 10.2 mm) was larger in obese patients, while left ventricular outflow tract diameter (19.5 ± 1.7 vs. 20.4 ± 2.1 mm) was smaller. Despite lower AVAi in obese patients (0.36 ± 0.10 vs. 0.43 ± 0.11 cm2/m2), there was lower mortality (37.5% vs. 41.0%, log-rank 4.06, p = 0.045) on follow-up (8.0 ± 5.7 years). After adjusting for age and AVA, higher BMI ≥ 27.5 kg/m2 remained protective for mortality (hazard ratio 0.38, 95% confidence interval 0.15 to 0.98, p = 0.046).<bold>Conclusion: </bold>We demonstrated that obesity was associated with improved survival in severe AS despite lower AVAi and increased prevalence of cardiovascular risk factors.
- Subjects
AORTIC stenosis; VENTRICULAR outflow obstruction; CARDIOVASCULAR diseases risk factors; AORTIC valve transplantation; VENTRICULAR ejection fraction; HEART valve prosthesis implantation; HEART failure; OBESITY; WAIST-hip ratio
- Publication
Singapore Medical Journal, 2022, Vol 63, Issue 6, p330
- ISSN
0037-5675
- Publication type
journal article
- DOI
10.11622/smedj.2020169