Obesity and risk of bleeding: the SMART study

Area of Science:

• Cardiology
• Hematology
• Metabolic Disorders

Background:

• Obesity is linked to a hypercoagulable state with increased procoagulant factors and reduced fibrinolysis.
• The protective effect of this hemostatic profile against bleeding events remains largely uninvestigated.

Purpose of the Study:

• To evaluate the association between various obesity measures and the risk of clinically relevant bleeding.
• To assess the impact of body mass index (BMI), waist, and hip circumference on bleeding events in a large patient cohort.

Main Methods:

• Analysis of 9736 patients from the Second Manifestation of ARTerial disease (SMART) study, aged 18-79 years.
• Median follow-up of 5.9 years, recording all fatal or non-fatal bleeding events.
• Assessment of body mass index (BMI), waist, and hip circumference at baseline.

Main Results:

• No significant association found between obesity and a lower risk of bleeding.
• Lowest body mass index (BMI) quintiles showed a higher bleeding risk, with a threshold effect observed.
• Waist circumference exhibited a U-shaped relationship with bleeding risk, with the lowest risk in the third quintile.

Conclusions:

• Obesity is not associated with a reduced risk of clinically relevant bleeding.
• The hemostatic advantages in obese individuals may be offset by other contributing factors, negating a protective effect against bleeding.