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. 2022 Nov 30:9:1032633.
doi: 10.3389/fcvm.2022.1032633. eCollection 2022.

The "obesity paradox" in patients with atrial fibrillation: Insights from the Gulf SAFE registry

Yan-Guang Li  1 , Peng-Xin Xie  1 , Alawi A Alsheikh-Ali  2 , Wael AlMahmeed  3 , Kadhim Sulaiman  4 , Nidal Asaad  5 , Shu-Wang Liu  1 , Mohammad Zubaid  6 , Gregory Y H Lip  7   8
Affiliations

The "obesity paradox" in patients with atrial fibrillation: Insights from the Gulf SAFE registry

Yan-Guang Li et al. Front Cardiovasc Med. .

Abstract

Background: The prognostic impact of obesity on patients with atrial fibrillation (AF) remains under-evaluated and controversial.

Methods: Patients with AF from the Gulf Survey of Atrial Fibrillation Events (Gulf SAFE) registry were included, who were recruited from six countries in the Middle East Gulf region and followed for 12 months. A multivariable model was established to investigate the association of obesity with clinical outcomes, including stroke or systemic embolism (SE), bleeding, admission for heart failure (HF) or AF, all-cause mortality, and a composite outcome. Restricted cubic splines were depicted to illustrate the relationship between body mass index (BMI) and outcomes. Sensitivity analysis was also conducted.

Results: A total of 1,804 patients with AF and recorded BMI entered the final analysis (mean age 56.2 ± 16.1 years, 47.0% female); 559 (31.0%) were obese (BMI over 30 kg/m2). In multivariable analysis, obesity was associated with reduced risks of stroke/systematic embolism [adjusted odds ratio (aOR) 0.40, 95% confidence interval (CI), 0.18-0.89], bleeding [aOR 0.44, 95%CI, 0.26-0.74], HF admission (aOR 0.61, 95%CI, 0.41-0.90) and the composite outcome (aOR 0.65, 95%CI, 0.50-0.84). As a continuous variable, higher BMI was associated with lower risks for stroke/SE, bleeding, HF admission, all-cause mortality, and the composite outcome as demonstrated by the accumulated incidence of events and restricted cubic splines. This "protective effect" of obesity was more prominent in some subgroups of patients.

Conclusion: Among patients with AF, obesity and higher BMI were associated with a more favorable prognosis in the Gulf SAFE registry. The underlying mechanisms for this obesity "paradox" merit further exploration.

Keywords: atrial fibrillation; body mass index; obesity; paradox; prognosis; stroke.

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Conflict of interest statement

Author NA was employed by Hamad Medical Corporation. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Body mass index and incident rates of clinical outcomes [(A) stroke and systematic embolism; (B) bleeding; (C) admission for atrial fibrillation; (D) admission for heart failure; (E) all-cause mortality; (F) composite outcome] per 100 patient-years. The bar represents confidence interval of incident rate.
FIGURE 2
FIGURE 2
The hazard ratio (95% CI) BMI as a continuous variable for clinical outcomes [(A) stroke and systematic embolism; (B) bleeding; (C) admission for atrial fibrillation; (D) admission for heart failure; (E) all-cause mortality; (F) composite outcome]. The solid red line is the multivariate adjusted odds ratio, and the pink shade represents the 95% confidence interval. Unrelated reference lines are represented by dotted lines.
FIGURE 3
FIGURE 3
Odds ratio and forest plots of outcomes [(A) stroke and systematic embolism; (B) bleeding; (C) admission for atrial fibrillation; (D) admission for heart failure; (E) all-cause mortality; (F) composite outcome] in subgroups of patients.
See this image and copyright information in PMC

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