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Obesity paradox in peripheral artery disease
Karsten Keller1, Lukas Hobohm1, Martin Geyer2
1Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.
Clinical Nutrition (Edinburgh, Scotland)
|October 17, 2018
Summary
Obesity is linked to lower in-hospital mortality in peripheral artery disease (PAD) patients, demonstrating an obesity survival paradox. Underweight patients, however, face higher mortality rates.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Peripheral artery disease (PAD) is a significant cardiovascular condition.
- Previous research indicated a potential survival advantage for obese patients with PAD, termed the obesity paradox.
- This study aimed to clarify the impact of obesity and underweight on in-hospital outcomes in PAD patients.
Purpose of the Study:
- To investigate the association between obesity, underweight, and adverse in-hospital outcomes in patients diagnosed with peripheral artery disease (PAD).
- To determine if the obesity survival paradox holds true across different classes of obesity in PAD patients.
- To compare in-hospital mortality rates between underweight, normal-weight/overweight, and obese PAD patients.
Main Methods:
- Utilized the German nationwide hospital database (01/2005-12/2015) including 5,611,484 inpatients diagnosed with PAD (ICD-code I70.2).
- Stratified patients into obesity, underweight, and normal-weight/overweight groups for comparative analysis.
- Analyzed in-hospital outcomes, focusing on mortality rates and adjusted odds ratios (OR) with 95% confidence intervals (CI).
Main Results:
- Obese PAD patients (8.9% of cohort) were younger, more frequently female, and had lower rates of cancer and major amputation compared to the reference group.
- Obesity was associated with significantly lower in-hospital mortality (3.2% vs. 5.1%; OR, 0.617 [95%CI 0.607-0.627]), observed across all obesity classes (I, II, and III).
- Underweight PAD patients (0.3% of cohort) exhibited higher in-hospital mortality (6.0% vs. 5.1%; OR, 1.179 [95%CI 1.106-1.257]) and a higher prevalence of cancer.
Conclusions:
- The study confirms an obesity survival paradox in PAD patients, with obesity linked to reduced in-hospital mortality.
- This survival advantage associated with obesity was independent of age, sex, and comorbidities.
- Underweight status in PAD patients is associated with increased in-hospital mortality, highlighting the importance of weight status in PAD outcomes.
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