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Association between obesity and prevalence of significant regurgitant valvular heart disease over time: A cohort
Damian Craiem1, Juan Moukarzel2, Mariano E Casciaro3
1Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina; Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMETTyB), Universidad Favaloro - CONICET, Buenos Aires, Argentina.
Insights
Obesity is linked to less valvular regurgitation and worsening, suggesting an obesity paradox in heart valve disease. This finding was consistent even after accounting for other factors.
Area of Science:
- Cardiology
- Obesity Medicine
- Epidemiology
Background:
- The relationship between obesity and valvular heart disease is not well-established.
- This study investigates the prevalence and progression of valvular regurgitation across different obesity categories.
Purpose of the Study:
- To determine the prevalence of valvular regurgitation in relation to body mass index (BMI).
- To assess the worsening of valvular regurgitation over time based on BMI categories.
Main Methods:
- A cohort study of 11,385 patients with two echocardiographic examinations at least one year apart.
- Grading of mitral, tricuspid, and aortic regurgitation at baseline and follow-up.
- Analysis of regurgitation worsening across body mass index (BMI) categories, adjusted for confounders.
Main Results:
- Prevalence of mitral, tricuspid, and aortic regurgitation decreased with increasing BMI categories (normal, overweight, obesity, severe obesity).
- Regurgitation worsening also showed a similar inverse trend with increasing BMI.
- These inverse associations remained significant after statistical adjustments.
Conclusions:
- Obesity is associated with a lower prevalence and reduced worsening of valvular regurgitation.
- This association, particularly for mitral and tricuspid valves, suggests an obesity paradox in valvular heart disease.
- Findings persisted after adjusting for confounders and excluding patients with weight changes.
Background:
The association between valvular heart disease and obesity is poorly documented. The present study evaluated the prevalence and worsening over time of valvular regurgitation by obesity category.
Methods:
This cohort study included 11385 patients who underwent two echocardiographic examinations at least 1 year apart. Mitral, tricuspid, and aortic regurgitation were graded at the first and last visits. Regurgitation worsening was defined as those going from non/trace to moderate/severe or from moderate to severe. Frequency and worsening of regurgitant valvular heart disease were evaluated across body mass index (BMI) categories and adjusted for age, sex, follow-up time, and significant regurgitation at first exam.
Results:
Patients aged 63 ± 15 years old at the last visit (43 % women, 29 % with obesity, median follow-up time of 3 years [interquartile range 2-6]). Valve regurgitation was more common in patients without obesity than in those with obesity across all age groups. The prevalence of mitral, tricuspid and aortic valve regurgitations at the last visit diminished for increased BMI categories: 24 %, 19 %, 16 % and 14 % for patients with normal weight, overweight, obesity and severe obesity, respectively (p < 0.001). The regurgitation worsening observed in any valve followed a similar trend: 14 %, 11 %, 9 % and 8 %, respectively (p < 0.001). These inverse associations with BMI remained significant after adjustments for cofactors.
Conclusions:
Obesity was associated with lower valvular regurgitation prevalence and worsening that persisted in the mitral and tricuspid valves after adjusting for confounders and excluding patients changing weight over time, suggesting the existence of an obesity paradox in valvular heart diseases.
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