The obesity paradox for outcomes in atrial fibrillation: Evidence from an exposure-effect analysis of prospective studies
Xiao Liu
Cardiology Department, The Second Affiliated Hospital of Nanchang University, Jiangxi, China
Search for more papers by this authorLinjuan Guo
Cardiology Department, The Second Affiliated Hospital of Nanchang University, Jiangxi, China
Search for more papers by this authorKaiwen Xiao
Jiangxi Medical College, Nanchang University, Jiangxi, China
Search for more papers by this authorWengen Zhu
Cardiology Department, The Second Affiliated Hospital of Nanchang University, Jiangxi, China
Search for more papers by this authorMenglu Liu
Cardiology Department, The Second Affiliated Hospital of Nanchang University, Jiangxi, China
Search for more papers by this authorRong Wan
Jiangxi Key Laboratory of Molecular Medicine, Jiangxi, China
Search for more papers by this authorCorresponding Author
Kui Hong
Cardiology Department, The Second Affiliated Hospital of Nanchang University, Jiangxi, China
Jiangxi Key Laboratory of Molecular Medicine, Jiangxi, China
Correspondence
Dr. Kui Hong, M.D., Ph.D., Cardiovascular Department, the Second Affiliated Hospital of Nanchang University, Jiangxi, 330006, China.
Email: hongkui88@163.com
Search for more papers by this authorXiao Liu
Cardiology Department, The Second Affiliated Hospital of Nanchang University, Jiangxi, China
Search for more papers by this authorLinjuan Guo
Cardiology Department, The Second Affiliated Hospital of Nanchang University, Jiangxi, China
Search for more papers by this authorKaiwen Xiao
Jiangxi Medical College, Nanchang University, Jiangxi, China
Search for more papers by this authorWengen Zhu
Cardiology Department, The Second Affiliated Hospital of Nanchang University, Jiangxi, China
Search for more papers by this authorMenglu Liu
Cardiology Department, The Second Affiliated Hospital of Nanchang University, Jiangxi, China
Search for more papers by this authorRong Wan
Jiangxi Key Laboratory of Molecular Medicine, Jiangxi, China
Search for more papers by this authorCorresponding Author
Kui Hong
Cardiology Department, The Second Affiliated Hospital of Nanchang University, Jiangxi, China
Jiangxi Key Laboratory of Molecular Medicine, Jiangxi, China
Correspondence
Dr. Kui Hong, M.D., Ph.D., Cardiovascular Department, the Second Affiliated Hospital of Nanchang University, Jiangxi, 330006, China.
Email: hongkui88@163.com
Search for more papers by this authorSummary
The impact of obesity on the prognosis of atrial fibrillation (AF) remains controversial. We conducted an exposure-effect meta-analysis of prospective studies to clarify the relationship between body mass index (BMI) and outcomes in patients with AF. The Cochrane Library, PubMed, and Embase databases were searched through May 1, 2019. Summary relative risks (RRs) were calculated using random-effects models. Nonlinear associations were explored using restricted cubic spline models. Twenty publications involving 161,922 individuals were included. Categorical variable analysis showed that underweight was associated with an increased risk of all-cause mortality (RR: 2.6), cardiovascular death (RR: 2.91), major bleeding (RR: 1.57), stroke or systemic embolism (RR: 1.62), and a composite endpoint (RR: 2.23). In exposure-effect analysis, the risk per 5 BMI increase was reduced for adverse outcomes (RR=0.86, 95% CI: 0.80-0.92 for all-cause death; RR=0.82, 95% CI: 0.71-0.95 for cardiovascular death; RR=0.89, 95% CI: 0.84-0.95 for stroke or systemic embolism; and RR=0.78, 95% CI: 0.67-0.92 for a composite endpoint). There was a significant “U”-shaped exposure-effect relationship with all-cause death, and the nadir of the curve was observed at a BMI of approximately 28. Our results showed that underweight is associated with a worse prognosis, but that overweight and obesity are associated with improved adverse outcomes in patients with AF.
CONFLICTS OF INTEREST
No conflict of interest was declared.
Supporting Information
Filename | Description |
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OBR12970-supp-0001-Supplemental publication material .docWord document, 544 KB |
Table S1. Quality assessment of the included studies Table S2: Relative risks between BMI and all-cause death, from the nonlinear dose-response analysis Table S3: Meta-regression results for body mass index and outcomes in patients with atrial fibrillation Figure S1. Forest plot of the association between BMI and all-cause death in patients with AF. Figure S2. Forest plot of the association between BMI and cardiovascular death in patients with AF. Figure S3. Forest plot of the association between BMI and SSE in patients with AF. Figure S4. Forest plot of the association between BMI and any stroke in patients with AF. Figure S5. Forest plot of the association between BMI and ischemic stroke in patients with AF. Figure S6. Forest plot of the association between BMI and major bleeding in patients with AF. Figure S7. Forest plot of the association between BMI and composite endpoint in patients with AF. Figure S8. Funnel plot for the association between BMI and outcomes in patients with AF. A) All-cause death (Egger's test, p=0.19); B) Cardiovascular death (Egger's test, p=0.20); C)Major bleeding (Egger's test, p=0.17); D)SSE (Egger's test, p=0.22); E)Composite endpoint (Egger's test, p=0.06). |
OBR12970-supp-0002-supple methods .docxWord 2007 document , 37.3 KB |
Data S1. Supporting Information |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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