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. 2020 Oct 21;18(2):229-237.
doi: 10.1513/AnnalsATS.202006-612OC. Online ahead of print.

Obesity in Pulmonary Arterial Hypertension (PAH): The Pulmonary Hypertension Association Registry (PHAR)

Jeff Min  1 , Rui Feng  2 , David Badesch  3 , Erika Berman-Rosenzweig  4 , Charles Burger  5 , Murali Chakinala  6 , Teresa De Marco  7 , Jeremy Feldman  8 , Anna Hemnes  9 , Evelyn M Horn  10 , Matthew R Lammi  11 , Stephen Mathai  12 , John W McConnell  13 , Kenneth Presberg  14 , Jeffrey Robinson  15 , Jeffrey Sager  16 , Oksana A Shlobin  17 , Marc Simon  18 , Thenappan Thenappan  19 , Corey Ventetuolo  20 , Nadine Al-Naamani  21 ; PHAR Investigators
Affiliations

Obesity in Pulmonary Arterial Hypertension (PAH): The Pulmonary Hypertension Association Registry (PHAR)

Jeff Min et al. Ann Am Thorac Soc. .

Erratum in

Abstract

Rationale: Obesity is associated with pulmonary arterial hypertension (PAH), but its impact on outcomes such as health-related quality of life (HRQoL), hospitalizations and survival is not well understood.

Objectives: To assess the effect of obesity on health-related quality of life (HRQoL), hospitalizations and survival in patients with PAH.

Methods: We performed a cohort study of adults with PAH from the Pulmonary Hypertension Association Registry, a prospective multicenter registry. Multivariate linear mixed effects regression was used to examine the relationship between weight categories and HRQoL using the Short Form-12 (SF-12) and emPHasis-10 (e10). We used multivariable negative binomial regression to estimate hospitalization incidence rate ratios (IRRs) and Cox regression to estimate hazard ratios (HRs) for transplant-free survival by weight status.

Results: 767 subjects were included: mean age of 57 years, 74% female, 33% overweight and 40% obese, with median follow-up duration of 527 days. Overweight and obese patients had higher baseline e10 scores (worse HRQoL), which persisted over time (p<0.001). The overweight and obese have a trend towards increased incidence of hospitalizations compared to normal weight (IRR 1.34, 95% confidence interval (95%CI) 0.94-1.92 and 1.33, 95%CI 0.93-1.89, respectively). Overweight and obese patients had lower risk of transplant or death as compared to normal weight patients (HR 0.45, 95%CI 0.25-0.80 and 0.39, 95%CI 0.22-0.70, respectively).

Conclusions: In a large multicenter, prospective cohort of PAH, overweight and obese patients had worse disease-specific HRQoL despite better transplant-free survival compared to normal weight patients. Future interventions should address the specific needs of these patients.

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Figures

Figure 1.
Figure 1.
Flowchart of study inclusion. BMI = body mass index; CTEPH = chronic thromboembolic pulmonary hypertension; PAH = pulmonary arterial hypertension; PPHN = persistent pulmonary hypertension of the newborn; PVOD = pulmonary veno-occlusive disease.
Figure 2.
Figure 2.
Health-related quality of life scores (HRQoL) by weight categories. Mean HRQoL measures and 95% confidence intervals for different weight categories. β coefficients are reported from multivariable mixed-effects generalized linear regression models. (A) emPHasis-10 scores (high score = worse HRQoL). (B) Short Form-12 physical scores (higher score = better HRQoL). (C) Short Form-12 mental scores (higher score = better HRQoL). SE = standard error; SF-12 = Short Form-12.
Figure 3.
Figure 3.
Interaction plot showing age as an effect modifier between body mass index and emPHasis-10 score, with sample density shown along the x-axis.
Figure 4.
Figure 4.
Transplant-free survival by weight status. Kaplan-Meier plot of transplant-free survival for weight categories from time of Pulmonary Hypertension Association Registry enrollment over a 2-year follow-up period.
See this image and copyright information in PMC

References

    1. Thenappan T, Ryan JJ, Archer SL. Evolving epidemiology of pulmonary arterial hypertension. Am J Respir Crit Care Med. 2012;186:707–709. - PMC - PubMed
    1. Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of obesity among adults and youth: United States, 2011-2014. NCHS Data Brief. 2015:1–8. - PubMed
    1. Ling Y, Johnson MK, Kiely DG, Condliffe R, Elliot CA, Gibbs JS, et al. Changing demographics, epidemiology, and survival of incident pulmonary arterial hypertension: results from the pulmonary hypertension registry of the United Kingdom and Ireland. Am J Respir Crit Care Med. 2012;186:790–796. - PubMed
    1. Poms AD, Turner M, Farber HW, Meltzer LA, McGoon MD. Comorbid conditions and outcomes in patients with pulmonary arterial hypertension: a REVEAL registry analysis. Chest. 2013;144:169–176. - PubMed
    1. Taraseviciute A, Voelkel NF. Severe pulmonary hypertension in postmenopausal obese women. Eur J Med Res. 2006;11:198–202. - PubMed