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Body mass index is inversely associated with mortality in patients with peripheral vascular disease
Jonathan Golledge1, Oliver Cronin, Vikram Iyer
1Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, James Cook University, Townsville 4811, Australia. jonathan.golledge@jcu.edu.au
Insights
Underweight patients with peripheral vascular disease (PVD) face double the mortality risk. Conversely, overweight and obesity are linked to a reduced risk of dying in PVD patients.
Area of Science:
- Cardiology
- Vascular Medicine
- Obesity Research
Background:
- Current guidelines lack management strategies for obesity and underweight in peripheral vascular disease (PVD) patients.
- This gap highlights the need to understand the prognostic implications of body weight in PVD.
Purpose of the Study:
- To investigate the association between underweight, overweight, obesity, and mortality in patients diagnosed with peripheral vascular disease (PVD).
Main Methods:
- Recruited 1472 patients with diverse PVD presentations.
- Defined underweight, overweight, and obesity using body mass index (BMI).
- Analyzed mortality associations using Kaplan-Meier and Cox proportional hazard models.
Main Results:
- Three-year survival rates were 37.5% (underweight), 78.1% (normal weight), 86.8% (overweight), and 87.0% (obese).
- Underweight patients had a 2.15-fold increased mortality risk (RR 2.15, p=0.003).
- Overweight (RR 0.67, p=0.011) and obese (RR 0.59, p=0.005) patients exhibited approximately half the mortality risk compared to normal weight individuals. Central obesity, indicated by high waist circumference, also correlated with reduced mortality (RR 0.50, p=0.045).
Conclusions:
- Obesity, assessed by BMI or central fat distribution, is associated with a lower risk of mortality in patients with established PVD.
- Underweight is a significant predictor of early mortality in the PVD population.
Background:
Current guidelines contain no advice on how to manage obesity and underweight in patients with peripheral vascular disease (PVD).
Objectives:
The aim of this study was to assess the association of underweight, overweight and obesity with mortality in patients with PVD.
Patients And Methods:
We recruited 1472 patients with a broad range of presentations of PVD. Underweight, overweight and obesity were defined by body mass index (BMI) and associated with mortality using Kaplan Meier and Cox proportional hazard analyses.
Results:
Survival at 3 years was 37.5, 78.1, 86.8 and 87.0% for patients that were underweight, normal weight, overweight and obese at recruitment, respectively, p<0.001. Patients that were underweight had approximately twice the risk of dying (RR 2.15, 95% CI 1.31-3.55, p=0.003), while patients that were overweight (RR 0.67, 95% CI 0.49-0.91, p=0.011) or obese (RR 0.59, 95% CI 0.41-0.85, p=0.005) had approximately half the risk of dying, after adjustment for other risk factors and using normal weight subjects as the reference group. 823 patients had waist circumference measured at recruitment. Patients with waist circumference in the top quartile had half the risk of dying (RR 0.50, 95% CI 0.26-0.98, p=0.045). In 267 patients we assessed the relationship between BMI and abdominal fat volumes using computed tomography. BMI was highly correlated with both intra-abdominal and subcutaneous fat volumes.
Conclusions:
Obesity whether assessed by BMI or central fat deposition is associated with reduced risk of dying in patients with established PVD. Underweight is highly predictive of early mortality in patients with PVD.
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