Advertisement

Obesity and Outcomes Among Patients With Established Atrial Fibrillation

      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/m2, overweight 25 to <30 kg/m2, obese ≥30 kg/m2). 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 randomized 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.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Pischon T.
        • Boeing H.
        • Hoffmann K.
        • Bergmann M.
        • Schulze M.B.
        • Overvad K.
        • van der Schouw Y.T.
        • Spencer E.
        • Moons K.G.
        • Tjonneland A.
        • Halkjaer J.
        • Jensen M.K.
        • Stegger J.
        • Clavel-Chapelon F.
        • Boutron-Ruault M.C.
        • Chajes V.
        • Linseisen J.
        • Kaaks R.
        • Trichopoulou A.
        • Trichopoulos D.
        • Bamia C.
        • Sieri S.
        • Palli D.
        • Tumino R.
        • Vineis P.
        • Panico S.
        • Peeters P.H.
        • May A.M.
        • Bueno-de-Mesquita H.B.
        • van Duijnhoven F.J.
        • Hallmans G.
        • Weinehall L.
        • Manjer J.
        • Hedblad B.
        • Lund E.
        • Agudo A.
        • Arriola L.
        • Barricarte A.
        • Navarro C.
        • Martinez C.
        • Quiros J.R.
        • Key T.
        • Bingham S.
        • Khaw K.T.
        • Boffetta P.
        • Jenab M.
        • Ferrari P.
        • Riboli E.
        General and abdominal adiposity and risk of death in Europe.
        N Engl J Med. 2008; 359: 2105-2120
        • McGee D.L.
        Body mass index and mortality: a meta-analysis based on person-level data from twenty-six observational studies.
        Ann Epidemiol. 2005; 15: 87-97
        • Manson J.E.
        • Willett W.C.
        • Stampfer M.J.
        • Colditz G.A.
        • Hunter D.J.
        • Hankinson S.E.
        • Hennekens C.H.
        • Speizer F.E.
        Body weight and mortality among women.
        N Engl J Med. 1995; 333: 677-685
        • Calle E.E.
        • Thun M.J.
        • Petrelli J.M.
        • Rodriguez C.
        • Heath Jr, C.W.
        Body-mass index and mortality in a prospective cohort of U.S. adults.
        N Engl J Med. 1999; 341: 1097-1105
        • Romero-Corral A.
        • Montori V.M.
        • Somers V.K.
        • Korinek J.
        • Thomas R.J.
        • Allison T.G.
        • Mookadam F.
        • Lopez-Jimenez F.
        Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies.
        Lancet. 2006; 368: 666-678
        • Oreopoulos A.
        • Padwal R.
        • Kalantar-Zadeh K.
        • Fonarow G.C.
        • Norris C.M.
        • McAlister F.A.
        Body mass index and mortality in heart failure: a meta-analysis.
        Am Heart J. 2008; 156: 13-22
        • Artham S.M.
        • Lavie C.J.
        • Milani R.V.
        • Ventura H.O.
        The obesity paradox: impact of obesity on the prevalence and prognosis of cardiovascular diseases.
        Postgrad Med. 2008; 120: 34-41
        • Kalantar-Zadeh K.
        • Block G.
        • Horwich T.
        • Fonarow G.C.
        Reverse epidemiology of conventional cardiovascular risk factors in patients with chronic heart failure.
        J Am Coll Cardiol. 2004; 43: 1439-1444
        • Wang T.J.
        • Parise H.
        • Levy D.
        • D'Agostino Sr, R.B.
        • Wolf P.A.
        • Vasan R.S.
        • Benjamin E.J.
        Obesity and the risk of new-onset atrial fibrillation.
        JAMA. 2004; 292: 2471-2477
        • Wanahita N.
        • Messerli F.H.
        • Bangalore S.
        • Gami A.S.
        • Somers V.K.
        • Steinberg J.S.
        Atrial fibrillation and obesity—results of a meta-analysis.
        Am Heart J. 2008; 155: 310-315
        • Wyse D.G.
        • Waldo A.L.
        • diMarco J.P.
        • Domanski M.J.
        • Rosenberg Y.
        • Schron E.B.
        • Kellen J.C.
        • Greene H.L.
        • Mickel M.C.
        • Dalquist J.E.
        • Corley S.D.
        A comparison of rate control and rhythm control in patients with atrial fibrillation.
        N Engl J Med. 2002; 347: 1825-1833
        • The Planning and Steering Committees of the AFFIRM study for the NHLBI AFFIRM investigators
        Atrial fibrillation follow-up investigation of rhythm management—the AFFIRM study design.
        Am J Cardiol. 1997; 79: 1198-1202
      1. Physical status: the use and interpretation of anthropometry.
        World Health Organ Tech Rep Ser. 1995; 854: 1-452
        • Watanabe H.
        • Tanabe N.
        • Watanabe T.
        • Darbar D.
        • Roden D.M.
        • Sasaki S.
        • Aizawa Y.
        Metabolic syndrome and risk of development of atrial fibrillation: the Niigata preventive medicine study.
        Circulation. 2008; 117: 1255-1260
        • Tsang T.S.
        • Barnes M.E.
        • Miyasaka Y.
        • Cha S.S.
        • Bailey K.R.
        • Verzosa G.C.
        • Seward J.B.
        • Gersh B.J.
        Obesity as a risk factor for the progression of paroxysmal to permanent atrial fibrillation: a longitudinal cohort study of 21 years.
        Eur Heart J. 2008; 29: 2227-2233
        • Jongnarangsin K.
        • Chugh A.
        • Good E.
        • Mukerji S.
        • Dey S.
        • Crawford T.
        • Sarrazin J.F.
        • Kuhne M.
        • Chalfoun N.
        • Wells D.
        • Boonyapisit W.
        • Pelosi Jr, F.
        • Bogun F.
        • Morady F.
        • Oral H.
        Body mass index, obstructive sleep apnea, and outcomes of catheter ablation of atrial fibrillation.
        J Cardiovasc Electrophysiol. 2008; 19: 668-672
        • Abdulla J.
        • Kober L.
        • Abildstrom S.Z.
        • Christensen E.
        • James W.P.
        • Torp-Pedersen C.
        Impact of obesity as a mortality predictor in high-risk patients with myocardial infarction or chronic heart failure: a pooled analysis of five registries.
        Eur Heart J. 2008; 29: 594-601
        • Mehta R.H.
        • Califf R.M.
        • Garg J.
        • White H.D.
        • Van de Werf F.
        • Armstrong P.W.
        • Pieper K.S.
        • Topol E.J.
        • Granger C.B.
        The impact of anthropomorphic indices on clinical outcomes in patients with acute ST-elevation myocardial infarction.
        Eur Heart J. 2007; 28: 415-424
        • Fonarow G.C.
        • Srikanthan P.
        • Costanzo M.R.
        • Cintron G.B.
        • Lopatin M.
        An obesity paradox in acute heart failure: analysis of body mass index and in-hospital mortality for 108,927 patients in the Acute Decompensated Heart Failure National Registry.
        Am Heart J. 2007; 153: 74-81
        • Curtis J.P.
        • Selter J.G.
        • Wang Y.
        • Rathore S.S.
        • Jovin I.S.
        • Jadbabaie F.
        • Kosiborod M.
        • Portnay E.L.
        • Sokol S.I.
        • Bader F.
        • Krumholz H.M.
        The obesity paradox: body mass index and outcomes in patients with heart failure.
        Arch Intern Med. 2005; 165: 55-61
        • Galal W.
        • van Gestel Y.R.
        • Hoeks S.E.
        • Sin D.D.
        • Winkel T.A.
        • Bax J.J.
        • Verhagen H.
        • Awara A.M.
        • Klein J.
        • van Domburg R.T.
        • Poldermans D.
        The obesity paradox in patients with peripheral arterial disease.
        Chest. 2008; 134: 925-930
        • Anker S.D.
        • Ponikowski P.
        • Varney S.
        • Chua T.P.
        • Clark A.L.
        • Webb-Peploe K.M.
        • Harrington D.
        • Kox W.J.
        • Poole-Wilson P.A.
        • Coats A.J.
        Wasting as independent risk factor for mortality in chronic heart failure.
        Lancet. 1997; 349: 1050-1053
        • Simoons M.L.
        • Bonneux L.
        Obesity, cardiology, and beyond.
        J Am Coll Cardiol. 2008; 52: 986-987
        • Mohamed-Ali V.
        • Goodrick S.
        • Bulmer K.
        • Holly J.M.
        • Yudkin J.S.
        • Coppack S.W.
        Production of soluble tumor necrosis factor receptors by human subcutaneous adipose tissue in vivo.
        Am J Physiol Endocrinol Metab. 1999; 277: E971-E975
        • Anker S.D.
        • Negassa A.
        • Coats A.J.
        • Afzal R.
        • Poole-Wilson P.A.
        • Cohn J.N.
        • Yusuf S.
        Prognostic importance of weight loss in chronic heart failure and the effect of treatment with angiotensin-converting-enzyme inhibitors: an observational study.
        Lancet. 2003; 361: 1077-1083

      Linked Article

      • Obesity Paradox in Outcomes of Atrial Fibrillation
        American Journal of CardiologyVol. 108Issue 3
        • Preview
          We read with great interest the report “Obesity and Outcomes Among Patients With Established Atrial Fibrillation” by Ardestani et al.1 The investigators present an inriguing analysis investigating the role of body mass index (BMI) and outcomes in atrial fibrillation (AF) from the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) trial. The investigators mention that “ours is the first study to assess the impact of obesity on morbidity and mortality in patients with established AF” and conclude that “in patients with established AF, overweight and obesity do not adversely affect overall survival.”1
        • Full-Text
        • PDF