Association of Body Mass Index With Clinical Outcomes in Patients With Atrial Fibrillation: A Report From the FANTASIIA Registry
Por:
Bertomeu-Gonzalez V, Moreno-Arribas J, Esteve-Pastor MA, Roldán-Rabadán I, Muñiz J, Raña-Míguez P, Ruiz-Ortiz M, Cequier Á, Bertomeu-Martínez V, Badimón L, Anguita M, Lip GYH and Marín F
Publicada:
7 ene 2020
Ahead of Print:
24 dic 2019
Categoría:
Cardiology and cardiovascular medicine
Resumen:
Background
Obesity and atrial fibrillation (AF) frequently coexist and independently increase mortality. We sought to assess the association between obesity and adverse events in patients receiving oral anticoagulants for AF.
Methods and Results
Consecutive AF outpatients receiving anticoagulant agents (both vitamin K antagonists and direct oral anticoagulants) were recruited into the FANTASIIA (Atrial fibrillation: influence of the level and type of anticoagulation on the incidence of ischemic and hemorrhagic stroke) registry. This observational, multicenter, and prospective registry of AF patients analyzes the quality of anticoagulation, incidence of events, and differences between oral anticoagulant therapies. We analyzed baseline patient characteristics according to body mass index, normal: <25 kg/m(2), overweight: 25-30 kg/m(2), and obese: >= 30 kg/m(2)), assessing all-cause mortality, stroke, major bleeding and major adverse cardiovascular events (a composite of ischemic stroke, myocardial infarction, and total mortality) at 3 years' follow-up. In this secondary prespecified substudy, the association of weight on prognosis was evaluated. We recruited 1956 patients (56% men, mean age 73.8 +/- 9.4 years): 358 (18.3%) had normal body mass index, 871 (44.5%) were overweight, and 727 (37.2%) were obese. Obese patients were younger (P<0.01) and had more comorbidities. Mean time in the therapeutic range was similar across body mass index categories (P=0.42). After a median follow-up of 1070 days, 255 patients died (13%), 45 had a stroke (2.3%), 146 a major bleeding episode (7.5%) and 168 a major adverse cardiovascular event (8.6%). Event rates were similar between groups for total mortality (P=0.29), stroke (P=0.90), major bleeding (P=0.31), and major adverse cardiovascular events (P=0.24). On multivariate Cox analysis, body mass index was not independently associated with all-cause mortality, cardiovascular mortality, stroke, major bleeding, or major adverse cardiovascular events.
Conclusions
In this prospective cohort of patients anticoagulated for AF, obesity was highly prevalent and was associated with more comorbidities, but not with poor prognosis.
Filiaciones:
:
Department of Cardiology Hospital Universitario de San Juan de Alicante Universidad Miguel Hernández Alicante Spain
Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares: CIBER-CV Madrid Spain
:
Department of Cardiology Hospital Universitario de San Juan de Alicante Universidad Miguel Hernández Alicante Spain
Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares: CIBER-CV Madrid Spain
Esteve-Pastor MA:
Department of Cardiology Hospital Clínico Universitario Virgen de la Arrixaca Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca) Murcia Spain
Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares: CIBER-CV Madrid Spain
Roldán-Rabadán I:
Department of Cardiology Hospital La Paz Madrid Spain
Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares: CIBER-CV Madrid Spain
Muñiz J:
Instituto Universitario de Ciencias de la Salud Instituto de Investigación Biomédica de A Coruña (INIBIC) Universidade da Coruña La Coruña Spain
Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares: CIBER-CV Madrid Spain
Raña-Míguez P:
ODDS, SL A Coruña Spain
Ruiz-Ortiz M:
Department of Cardiology Hospital Universitario Reina Sofía Córdoba Spain
Cequier Á:
Department of Cardiology Hospital de Bellvitge Barcelona Spain
Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares: CIBER-CV Madrid Spain
:
Department of Cardiology Hospital Universitario de San Juan de Alicante Universidad Miguel Hernández Alicante Spain
Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares: CIBER-CV Madrid Spain
Badimón L:
Cardiovascular Research Center (CSIC-ICCC) Hospital de la Santa Creu i Sant Pau Barcelona Spain
Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares: CIBER-CV Madrid Spain
Anguita M:
Department of Cardiology Hospital Universitario Reina Sofía Córdoba Spain
Lip GYH:
Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool United Kingdom
Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark
Marín F:
Department of Cardiology Hospital Clínico Universitario Virgen de la Arrixaca Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca) Murcia Spain
Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares: CIBER-CV Madrid Spain
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