Influence of obesity on outcomes in atrial fibrillation: yet another obesity paradox. Relation of Nonvalvular Atrial Fibrillation to Body Mass Index (from the SPORTIF Trials). Obesity and outcomes among patients with established atrial fibrillation. The long- and short-term impact of elevated body mass index on the risk of new atrial fibrillation the WHS (women's health study). Relationship between body mass index and left atrial appendage thrombus in nonvalvular atrial fibrillation Catheter Ablation for Atrial Fibrillation in Patients With Obesity Body mass index and adverse events in patients with incident atrial fibrillation. Overweight and obesity as risk factors for atrial fibrillation or flutter: the Danish Diet, Cancer, and Health Study. Cardiovascular risk in relation to body mass index and use of evidence-based preventive medications in patients with or at risk of atherothrombosis. Obesity, Brain Natriuretic Peptide Levels and Mortality in Patients Hospitalized With Heart Failure and Preserved Left Ventricular Systolic Function Physical Activity, Obesity, Weight Change, and Risk of Atrial Fibrillation: The Atherosclerosis Risk in Communities Study Abdominal obesity and all-cause and cardiovascular mortality in end-stage renal disease. Body composition is associated with clinical outcomes in patients with non-dialysis-dependent chronic kidney disease. Prevalence of overweight and obesity in a rural southern Italy population and relationships with total and cardiovascular mortality: the Ventimiglia di Sicilia project Relationship of physical fitness vs body mass index with coronary artery disease and cardiovascular events in women. Mediterranean Diet and Health Outcomes in the SUN Cohort Predictors of major adverse cardiovascular events; results of population based MELEN study with prospective follow-up. Atrial Fibrillation Following Out-of-Hospital Cardiac Arrest and Targeted Temperature Management—Are We Giving It the Attention it Deserves?* Obesity paradox in patients with hypertension and coronary artery disease. Body mass index and mortality in acutely decompensated heart failure across the world: a global obesity paradox. Obesity, Physical Activity, and Their Interaction in Incident Atrial Fibrillation in Postmenopausal Women Insulin Resistance and Cardiovascular Risk Factors in 3- to 5-Year-Old Overweight or Obese Children Big men and atrial fibrillation: effects of body size and weight gain on risk of atrial fibrillation in men.
BACKGROUND Obese patients have favorable outcomes in congestive heart failure , hypertension , peripheral vascular disease , and coronary artery disease . Obesity also has been linked with increased incidence of atrial fibrillation , but its influence on outcomes in atrial fibrillation patients has not been investigated . The objective of this research is to investigate the effect of obesity on outcomes in atrial fibrillation . METHODS The Atrial Fibrillation Follow-up Investigation of Rhythm Management ( AFFIRM ) study was one of the largest multicenter trials of atrial fibrillation , with 4060 patients . Subjects were r and omized to rate versus rhythm-control strategy . We performed a post hoc analysis of the National Heart , Lung and Blood Institute limited access data set of atrial fibrillation patients who had body mass index ( BMI ) data available in the AFFIRM study . BMI data were not available on 1542 patients . Patients with BMI > or=18.5 were split into normal ( 18.5 - 25 ) , overweight ( 25 - 30 ) , and obese ( > 30 ) categories as per BMI ( kg/m(2 ) ) . Multivariate Cox proportional hazards regression was used on the eligible 2492 patients . End points were all-cause mortality and cardiovascular mortality . RESULTS Over three fourths of all patients in our cohort were overweight or obese . There were 304 deaths ( 103 among normal weight , 108 among overweight , and 93 among obese ) and 148 cardiovascular deaths ( 54 among normal weight , 41 among overweight , and 53 among obese ) over a mean period of 3 years of patient follow-up . On multivariate analysis , overweight ( hazard ratio [ HR ] 0.64 ; 95 % confidence interval [ CI ] , 0.48 - 0.84 ; P=.001 ) and obese ( HR 0.80 ; 95 % CI , 0.68 - 0.93 ; P=.005 ) categories were associated with lower all-cause mortality as compared with normal weight . Overweight ( HR 0.40 ; 95 % CI , 0.26 - 0.60 ; P < .001 ) and obese patients ( HR 0.77 ; 95 % CI , 0.62 - 0.95 ; P=.01 ) also had lower cardiovascular mortality as compared with the normal weight patients . CONCLUSIONS Although in prior studies , obesity has been associated with increased risk of atrial fibrillation , an obesity paradox exists for outcomes in atrial fibrillation . Obese patients with atrial fibrillation appear to have better long-term outcomes than nonobese patients Obesity is well-established as a major cardiovascular ( CV ) risk factor . Obesity confers a greater risk for developing atrial fibrillation ( AF ) , but the relation between obesity and established nonvalvular AF for stroke and all-cause death is still unclear . To ascertain the prevalence of overweight and obesity in patients with nonvalvular AF , their influence on adverse events , and the relation with anticoagulation control , we performed this post hoc analysis of the pooled Stroke Prevention using an Oral Thrombin Inhibitor in patients with atrial Fibrillation ( SPORTIF ) III and V data sets . For this study , we analyzed all patients assigned to the warfarin arm with data on body mass index ( BMI ) . Time in therapeutic range was used as an index of the quality of anticoagulation control . The 3,630 patients eligible for this analysis were categorized as follows : ( 1 ) BMI 18.5 to 24.9 ( " normal weight " ) in 24.1 % ; ( 2 ) BMI 25.0 to 29.9 ( " overweight " ) in 39.8 % ; and BMI ≥30 ( " obese " ) in 36.1 % . Both overweight ( hazard ratio [ HR ] 0.70 ) and obese ( HR 0.59 ) categories were inversely associated with the composite outcome of stroke/all-cause death . A similar inverse association was seen for the end point of stroke ( HR 0.61 and 0.47 , respectively ) . Good anticoagulation control also attenuated the association between BMI categories and outcomes . In patients with time in therapeutic range > 70 % , BMI category was not significantly associated with the composite outcome of stroke/death and stroke . Stroke and all-cause death progressively reduced in overweight and obese anticoagulated patients with AF . The inverse relation of BMI categories to the risk of stroke and all-cause death was mitigated by good anticoagulation control Atrial fibrillation ( AF ) and obesity have reached epidemic proportions . The impact of obesity on clinical outcomes in patients with established AF is unknown . We analyzed 2,492 patients in the Atrial Fibrillation Follow-Up Investigation of Rhythm Management ( AFFIRM ) study .  Body mass index ( BMI ) was evaluated as a categorical variable ( normal 18.5 to < 25 kg/m(2 ) , overweight 25 to < 30 kg/m(2 ) , obese > or=30 kg/m(2 ) ) . Rate of death from any cause was higher in the normal BMI group ( 5.8 per 100 patient-years ) than in the overweight and obese groups ( 3.9 and 3.7 , respectively ) . Cardiovascular death rate was highest in the normal BMI group ( 3.1 per 100 patient-years ) , lowest in the overweight group ( 1.5 per 100 patient-years ) , and intermediate in the obese group ( 2.1 per 100 patient-years ) . After adjustment for baseline factors , differences in risk of death from any cause were no longer significant . However , overweight remained associated with a lower risk of cardiovascular death ( hazard ratio 0.47 , p = 0.002 ) . Obese patients were more likely to have an uncontrolled heart rate at rest , but rhythm-control strategy success was similar across BMI categories . In each BMI category , risk of death from any cause was similar for patients r and omized to a rhythm- or rate-control strategy . In conclusion , in patients with established AF , overweight and obesity do not adversely affect overall survival . Obesity does not appear to affect the relative benefit of a rate- or rhythm-control strategy OBJECTIVES The purpose of this study was to characterize the relationship between changes in  body mass index ( BMI ) and incident atrial fibrillation ( AF ) in a large cohort of women . BACKGROUND Obesity and AF are increasing public health problems . The importance of dynamic obesity-associated AF risk is uncertain , and mediators are not well characterized . METHODS Cases of AF were confirmed by medical record review in 34,309 participants in the Women 's Health Study . Baseline and up date d measures of  BMI  were obtained from periodic question naires . RESULTS During 12.9 + /- 1.9 years of follow-up , 834 AF events were confirmed . BMI was linearly associated with AF risk , with a 4.7 % ( 95 % confidence interval [ CI ] : 3.4 to 6.1 , p < 0.0001 ) increase in risk with each kilogram per square meter . Adjustment for inflammatory markers minimally attenuated this risk . When up date d measures of BMI were used to estimate dynamic risk , overweight ( hazard ratio [ HR ] : 1.22 ; 95 % CI : 1.02 to 1.45 , p = 0.03 ) , and obesity ( HR : 1.65 ; 95 % CI : 1.36 to 2.00 ; p < 0.0001 ) were associated with adjusted short-term increases in AF risk . Participants becoming obese during the first 60 months had a 41 % adjusted increase in risk of the development of AF ( p = 0.02 ) compared with those maintaining BMI < 30 kg/m(2 ) . The prevalence of overweight and obesity increased over time . The adjusted proportion of incident AF attributable to short-term elevations in BMI was substantial ( 18.3 % ) . CONCLUSIONS In this population of apparently healthy women , BMI was associated with short- and long-term increases in AF risk , accounting for a large proportion of incident AF independent of traditional risk factors . A strategy of weight control may reduce the increasing incidence of AF . ( Women 's Health Study [ WHS ] : A R and omized Trial of Low-Dose Aspirin and Vitamin E in the Primary Prevention of Cardiovascular Disease and Cancer ; NCT00000479 ) Atrial fibrillation and obesity are two major growing epidemics in the United States and globally . Obese people are at the increased risk of developing atrial fibrillation . The contribution of obesity as an independent risk factor for stroke in the setting of atrial fibrillation remains unclear . We tested the hypothesis that non-valvular atrial fibrillation ( NVAF ) patients with increased body mass index ( BMI ) would be at increased risk for the development of left atrial appendage thrombus ( LAAT ) .  Consecutive , anticoagulation naïve patients with NVAF referred for a transesophageal echocardiogram ( TEE ) between January 1 , 2007 and October 21 , 2009 were approached for study participation . All clinical , laboratory , and TEE measurement data were collected prospect ively . Within a group of 400 anticoagulation naïve NVAF patients ( mean age 63 ± 15 years , 28 % women ; 17 % with LAAT )  the prevalence of LAAT was similar across all BMI categories ( normal 13 % , overweight 19 % , obese 16 % , morbidly obese 16 % ; p = 0.71 ) . Despite a higher CHADS2 score and a higher prevalence of both hypertension and diabetes mellitus , elevated BMI was not an independent predictor of LAAT when analyzed as either a continuous variable , across BMI WHO categories , a dichotomous variable stratified at values above versus below 27 kg/m2 , or BMI stratified on atrial fibrillation duration . Despite a higher prevalence of major risk factors for thromboembolism , the prevalence of LAAT was not increased in overweight , obese , and morbidly obese patients Background — Obesity is a risk factor for atrial fibrillation and other cardiovascular conditions . Our objective was to determine whether catheter-based ablation effectively treated atrial fibrillation in obese patients . Methods and Results — Five hundred twenty-three consecutive patients with symptomatic , medication-refractory atrial fibrillation underwent catheter ablation .  Patients were grouped by body mass index ( lean , < 25 kg/m2 ; overweight , 25 to 29.9 kg/m2 ; obese , ≥30 kg/m2 ) . Outcome and quality of life were measured with a general health survey ( Medical Outcomes Study 36-item Short-Form General Health Survey [ SF-36 ] ) ; patients were assessed before ablation and at 3 and 12 months after the procedure . Two hundred twenty-eight study patients ( 44 % ) were overweight , and 201 ( 38 % ) were obese . Twelve months after curative ablation , 72 % of patients were free of atrial fibrillation without the use of antiarrhythmic agents ; 84 % were arrhythmia free when those receiving medication were included . Atrial fibrillation was eliminated in 75 % , 72 % , and 70 % of the lean , overweight , and obese patients , respectively , at 12 months ( P=0.41 , trend test ) . SF-36 scores were lower for patients with higher body mass index ( P<0.05 ) at baseline . SF-36 scores improved in every functional domain for all body mass index groups after ablation . The mean SF-36 total physical score increased from 59±20 at baseline to 77±19 in 12 months ( P<0.001 ) . The total mental health score improved from 66±18 to 79±16 in 12 months ( P<0.001 ) . Conclusions — Catheter ablation of atrial fibrillation was effective in obese patients . Coexistence of atrial fibrillation and obesity indicated lower SF-36 scores , but the improvement in quality of life was consistent across all body mass index categories BACKGROUND Obesity is associated with the development of atrial fibrillation and may impact atrial fibrillation-related outcomes . To date , no anthropometric measure is included in any risk stratification scheme for stroke and death in atrial fibrillation patients . METHODS The prospect i ve Danish Diet , Cancer and Health study is a cohort including 57,053 participants ( 27,178 men and 29,875 women ) aged between 50 and 64 years . The study population for this study included the 3135 patients ( 2025 men and 1110 women ) who developed incident atrial fibrillation during follow-up . RESULTS Of the subjects with atrial fibrillation , 1414 ( 45 % ) had a body mass index ( BMI ) in the overweight category ( BMI 25 to < 30 kg/m(2 ) ) and 767 ( 24 % ) were categorized as obese ( BMI ≥30 kg/m(2 ) ) . During a median follow-up of 4.9 years , 609 deaths and 216 thromboembolic events ( 98 % ischemic strokes ) occurred . Using normal-weight patients as reference , the risk of a composite end point of " ischemic stroke , thromboembolism , or death " was significantly higher in overweight ( crude hazard ratio [ HR ] 1.31 ; 95 % confidence interval [ CI ] , 1.09 - 1.56 ) and obese patients ( crude HR 1.55 ; 95 % CI 1.27 - 1.90 ) . After adjustment for CHADS2 and CHA2DS2-VASc scores , the HRs for the composite end point were 1.21 ( 95 % CI 1.02 - 1.45 ) and 1.31 ( 95 % CI 1.10 - 1.56 ) , respectively , for overweight and 1.25 ( 95 % CI 1.03 - 1.53 ) and 1.36 ( 95 % CI 1.11 - 1.65 ) , respectively , for obese . Continuous analyses of BMI stratified by sex identified obese men and normal-weight women as the sex-specific " high-risk " categories . CONCLUSION Overweight and obesity are risk factors for " ischemic stroke , thromboembolism or death " in patients with atrial fibrillation , even after adjustment for CHADS2 and CHA2DS2-VASc scores . The association between BMI and outcomes among atrial fibrillation patients may be modified by sex PURPOSE We examined the association between the body mass index analyzed as a continuous variable and by categorization according to World Health Organization criteria ( normal weight , overweight and obesity ) and the risk of a hospital ( inpatient as well as outpatient ) diagnosis of atrial fibrillation or flutter . METHODS Population -based prospect i ve cohort study conducted from December 1993 to December 2001 among 47589 participants ( 22482 men and 25107 women ) without preexisting cardiovascular or endocrine disease and with a mean age at baseline of 56 years ( range 50 - 64 years ) in the Danish Diet , Cancer , and Health Study . Subjects were followed up in the Danish National Registry of Patients and in the Danish Civil Registration System . RESULTS During follow-up ( mean , 5.7 years ) atrial fibrillation or flutter developed in 553 subjects ( 372 men and 181 women ) . The adjusted hazard ratio for atrial fibrillation or flutter per unit of increase in the body mass index was 1.08 ( 95 % confidence interval [ CI ] : 1.05 to 1.11 ) in men and 1.06 ( 95 % CI : 1.03 to 1.09 ) in women . When using normal weight as a reference , the adjusted hazard ratio for atrial fibrillation or flutter by overweight was 1.75 ( 95 % CI : 1.35 to 2.27 ) in men and 1.39 ( 95 % CI : 0.99 to 1.94 ) in women . The adjusted hazard ratio by obesity was 2.35 ( 95 % CI : 1.70 to 3.25 ) in men and 1.99 ( 95 % CI : 1.31 to 3.02 ) in women . CONCLUSION Overweight and obesity are associated with an increased risk of a diagnosis of atrial fibrillation or flutter AIM Explore the relation between body mass index ( BMI ) and cardiovascular disease , and the influence of optimal medical therapy ( OMT ) on this relationship . METHODS AND RESULTS Patients from the REACH cohort , an international , prospect i ve cohort of patients with or at high risk of atherosclerosis with documentation of potential confounders , including treatments and risk factors , were followed up to 4 years ( n = 54 285 ) . Patients were categorized according to baseline BMI ( ranging from underweight to Grade III obesity ) . Optimal medical therapy was defined as the use of the four cardioprotective medication classes ( statins , ACE inhibitors/angiotensin II receptor blockers , β-blockers , and antiplatelet agents ) . The main outcomes were all-cause mortality , cardiovascular ( CV ) mortality , and CV events . In primary and secondary prevention , a reverse J-shaped curve best described the relationship between BMI categories and the incidence of the various outcomes . In secondary prevention , the highest adjusted risks were observed for underweight patients ( 1.97 , P < 0.01 , and 1.29 , P = 0.03 , for CV mortality and CV events ) and the lowest HRs were observed , respectively , in Grade II and Grade III obese patients ( 0.73 , P < 0.01 and 0.80 , P < 0.01 ) . The proportion of patients on OMT increased with BMI from 10.1 to 36 % ( P < 0.001 ) . The apparent CV protection conferred by obesity persisted in patients receiving OMT . CONCLUSION An obesity paradox was observed in both primary and secondary CV prevention patients . The intensity of use of evidence -based preventive medications does not account for the paradoxical CV protection associated with obesity . At extremes of BMI , further interventions beyond OMT may be needed to reduce CV risk Background : An inverse relationship between brain natriuretic peptide ( BNP ) levels and body mass index ( BMI ) has been described for patients with left ventricular ( LV ) systolic dysfunction . In this study , the association of BMI , BNP levels and mortality in patients hospitalized for heart failure with preserved LV systolic function ( HFpLVF ) was investigated . Methods : One hundred fifty consecutive patients ( 98 % men ) who were hospitalized with HFpLVF and had BNP levels measured on admission were analyzed . Patients were divided into categories of BMI : normal ( BMI < 25 kg/m2 ) , overweight ( BMI 25–29.9 kg/m2 ) and obese ( BMI ≥ 30 kg/m2 ) . Relevant clinical and echocardiographic characteristics and all-cause mortality were obtained through chart review . Results : BNP levels were significantly lower in obese ( median = 227 pg/mL ) and overweight ( median = 396 pg/mL ) patients compared with those with normal BMI ( median = 608 pg/mL , P = 0.003 ) . Higher BMI predicted BNP levels of < 100 pg/mL. Compared with patients with normal BMI , overweight and obese patients had a significantly lower risk of total mortality , even after adjusting for other clinical characteristics , including log-transformed BNP levels , atrial fibrillation , the use of beta-blockers at discharge , age , hemoglobin levels and the presence of pulmonary congestion on admission . Higher BNP levels also independently predicted mortality . Conclusions : An inverse relationship between BMI and BNP levels exists in patients hospitalized with HFpLVF . Higher BMI is associated with lower mortality , whereas higher BNP levels predict higher mortality in male patients with HFpLVF . These findings should be confirmed in a larger multicenter setting Background —Physical activity ( PA ) has previously been suggested to attenuate the risk of atrial fibrillation ( AF ) conferred by excess body weight and weight gain . We prospect ively examined the relationship between body size , weight change , and level of PA in a biracial cohort of middle-aged men and women . Methods and Results —Baseline characteristics on risk factor levels were obtained on 14 219 participants from the Atherosclerosis Risk in Communities Study . AF incidence was ascertained from 1987 to 2009 . Adjusted Cox proportional hazards models were used to estimate the associations between body mass index , waist circumference , relative weight change , and PA level with incident AF . During follow-up , there were 1775 cases of incident AF . Body mass index and waist circumference were positively associated with AF as was weight loss/gain of > 5 % initial body weight . An ideal level of PA had a small protective effect on AF risk and partially attenuated the risk of AF associated with excess weight in men but not women : compared with men with a normal body mass index , the risk of AF in obese men with an ideal , intermediate , and poor level of PA at baseline was increased by 37 % , 129 % , and 156 % ( Pinteraction=0.04 ) . During follow-up , PA did not modify the association between weight gain and risk of AF . Conclusions —Obesity and extreme weight change are risk factors for incident AF , whereas being physically active is associated with a small reduction in risk . In men only , being physically active offset some , but not all , of the risk incurred with excess body weight OBJECTIVE The aim of this study was to investigate the predictive value for all-cause and cardiovascular ( CV ) death of anthropometric measurements of abdominal obesity in patients with end-stage renal disease ( ESRD ) . BACKGROUND Surrogate measures of abdominal obesity and segmental fat distribution ( waist circumference and waist/hip ratio [ WHR ] ) are stronger predictors of all-cause and CV death than body mass index ( BMI ) in the general population , but the issue has never been investigated in patients with ESRD . METHODS We performed a prospect i ve cohort study in 537 patients with ESRD ( age 63 + /- 15 years ) . RESULTS In BMI -adjusted Cox models , waist circumference was a direct predictor of all-cause and CV mortality ( p < 0.001 ) , whereas BMI showed an inverse relationship ( p < 0.001 ) with these outcomes . The incidence rates of overall and CV death were maximal in patients with relatively lower BMI scores ( below the median ) and higher waist circumferences ( at least the median ) and minimal in patients with higher BMI scores ( at least the median ) and small waist circumferences ( below the median ) . The prognostic power of waist circumference for all-cause ( hazard ratio [ HR ] [ 10-cm increase ] : 1.23 ; 95 % confidence interval [ CI ] : 1.02 to 1.47 ; p = 0.03 ) and CV mortality ( HR : 1.37 ; 95 % CI : 1.09 to 1.73 ; p = 0.006 ) remained significant after adjustment for CV comorbidities and traditional and emerging risk factors . WHR was found to be related to all-cause ( p = 0.009 ) and CV mortality ( p = 0.07 ) . CONCLUSIONS Abdominal obesity underlies a high risk of all-cause and CV mortality in patients with ESRD . Redefinition of nutritional status by combining the metrics of abdominal obesity and BMI may refine prognosis in the ESRD population An inverse relationship between body mass index ( BMI ) and mortality ( the obesity paradox ) has been found in patients with non-dialysis-dependent chronic kidney disease ( CKD ) . However , it is unclear whether increased muscle mass or body fat confers the survival advantage . To resolve this we investigated the impact of body makeup on a composite outcome of death or cardiovascular events in a prospect i ve cohort of 326 patients with stage 3 - 5 CKD not yet on dialysis .  Lean mass and body fat were determined using the Body Composition Monitor , a multifrequency bioimpedance spectroscopy device , and were expressed as the lean tissue or fat tissue index , respectively . Patients were stratified as High ( above median ) or Low ( below median ) BMI , High or Low lean tissue index , or as High or Low fat tissue index . During a median follow-up of 4.6 years , there were 40 deaths and 68 cardiovascular events . In Cox proportional hazards models , a High lean tissue index , but not High BMI or High fat tissue index , predicted a lower risk of both the composite or its component outcomes ( reference : below median ) . When patients were further stratified into four distinct body composition groups based on both the lean and fat tissue index , only the High lean/fat tissue index group had a significantly lower risk of the composite outcome ( hazard ratio 0.36 , 95 % confidence interval 0.14 - 0.87 ; reference : Low lean/fat tissue index group ) . Thus , the lean tissue index can provide better risk prediction than the BMI alone in non-dialysis-dependent patients with CKD . The High lean/fat tissue index appears to be associated with best outcomes . An optimal body composition for improving the prognosis of CKD needs to be determined OBJECTIVE : We investigated the prevalence of overweight and obesity and their relationships with the main cardiovascular risk factors in the population of Ventimiglia di Sicilia , a rural village in Southern Italy characterized by low cholesterol levels and by a low incidence of early coronary heart disease mortality . We related all deaths to body weight and fat distribution during an 8 y follow-up . DESIGN : Cross-sectional and prospect i ve observational study .SUBJECTS : A total of 835 free-living individuals , 363 males and 472 females , of age between 20 and 69 y. MEASUREMENTS : In all participants body weight , waist-to-hip ratio ( WHR ) , cardiovascular risk factors and plasma lipids were measured . During the follow-up , total and cardiovascular deaths were registered . RESULTS : We found a high overall prevalence of subjects with overweight or obesity ( respectively 45.0 % and 27.7 % ) , with great differences among classes of age . As expected , body weight and fat distribution were associated with diabetes , hypertension , dyslipidemia and with a worsening of lipid profile . During the follow-up we registered 37 total and 11 cardiovascular deaths . All-cause and cardiovascular mortality risks were , respectively , 1.64 ( 95 % CI 0.65–4.15 ) and 2.71 ( 95 % CI 0.29–25.26 ) in subjects with a body mass index ( BMI ) of 27–29.99 kg/m2 and 2.45 ( 95 % CI 1.03–5.87 ) and 5.36 ( 95 % CI 1.41–62.01 ) in subjects with a BMI of≥30 kg/m2 in comparison with participants with a BMI of < 27 kg/m2 , and 3.48 ( 95 % CI 1.46–8.30 ) and 4.55 ( 95 % CI 1.12–18.40 ) in subjects with a WHR higher than the median in comparison with individuals with a WHR lower than the median . CONCLUSION : The Ventimiglia di Sicilia Study highlights the great importance of overweight and obesity as a public health issue in a rural population and indicates that it is necessary to consider the impact of body weight and fat distribution on both total and CHD mortality CONTEXT Individual contributions of obesity and physical fitness ( physical activity and functional capacity ) to risk of coronary heart disease in women remain unclear . OBJECTIVE To investigate the relationships of measures of obesity ( body mass index [ BMI ] , waist circumference , waist-hip ratio , and waist-height ratio ) and physical fitness ( self-reported Duke Activity Status Index [ DASI ] and Postmenopausal Estrogen-Progestin Intervention question naire [ PEPI-Q ] scores ) with coronary artery disease ( CAD ) risk factors , angiographic CAD , and adverse cardiovascular ( CV ) events in women evaluated for suspected myocardial ischemia . DESIGN , SETTING , AND PARTICIPANTS The National Heart , Lung , and Blood Institute-sponsored Women 's Ischemia Syndrome Evaluation ( WISE ) is a multicenter prospect i ve cohort study . From 1996 - 2000 , 936 women were enrolled at 4 US academic medical centers at the time of clinical ly indicated coronary angiography and then assessed ( mean follow-up , 3.9 [ SD , 1.8 ] years ) for adverse outcomes . MAIN OUTCOME MEASURES Prevalence of obstructive CAD ( any angiographic stenosis > or=50 % ) and incidence of adverse CV events ( all-cause death or hospitalization for nonfatal myocardial infa rct ion , stroke , congestive heart failure , unstable angina , or other vascular events ) during follow-up . RESULTS Of 906 women ( mean age , 58 [ SD , 12 ] years ) with complete data , 19 % were of nonwhite race , 76 % were overweight ( BMI > or=25 ) , 70 % had low functional capacity ( DASI scores < 25 , equivalent to < or=7 metabolic equivalents [ METs ] ) , and 39 % had obstructive CAD . During follow-up , 337 ( 38 % ) women had a first adverse event , 118 ( 13 % ) had a major adverse event , and 68 ( 8 % ) died . Overweight women were more likely than normal weight women to have CAD risk factors , but neither BMI nor abdominal obesity measures were significantly associated with obstructive CAD or adverse CV events after adjusting for other risk factors ( P = .05 to.88 ) . Conversely , women with lower DASI scores were significantly more likely to have CAD risk factors and obstructive CAD ( 44 % vs 26 % , P<.001 ) at baseline , and each 1-MET increase in DASI score was independently associated with an 8 % ( hazard ratio , 0.92 ; 95 % confidence interval , 0.85 - 0.99 ; P = .02 ) decrease in risk of major adverse CV events during follow-up . CONCLUSIONS Among women undergoing coronary angiography for suspected ischemia , higher self-reported physical fitness scores were independently associated with fewer CAD risk factors , less angiographic CAD , and lower risk for adverse CV events . Measures of obesity were not independently associated with these outcomes The Mediterranean Dietary ( MedDiet ) Pattern has been linked to many beneficial health effects . This review summarizes the main findings of a prospect i ve cohort study , the Seguimiento Universidad de Navarra ( SUN ) cohort , specifically focused on MedDiet and the risk of major chronic disease . It is an open cohort in which 22,786 Spanish university graduates have participated since 1999 until February 2018 . Data on diet , lifestyle and clinical diagnosis are collected at baseline and every two years . After review ing 21 publications from the SUN cohort on the effects of the MedDiet , we conclude that this cohort has provided good evidence that a high MedDiet adherence is associated with a reduced incidence of all-cause mortality , fatal and non-fatal major cardiovascular disease ( CVD ) , type 2 diabetes , weight gain , metabolic syndrome , depression , cognitive decline , and nephrolithiasis . An inverse dose-response relationship was found for many of these associations . The MedDiet was also associated with lower average heart rate , a mitigation of the harmful effects of overweight/obesity on the risk of CVD , and an attenuation of the effects of obesity on type 2 diabetes . A suggestion that the MedDiet may enhance fertility was also found OBJECTIVE In healthy persons , cardiovascular risk is the result of multiple interacting risk associates including demographic , clinical , genetic and environmental factors . Several non-invasive tools such as echocardiography , ultrasonography and electrocardiography as well as new biochemical markers were shown to be applicable to predict cardiovascular events . However , implementation of all of these tools has not been tested before . The aim of the study was to evaluate the independent predictors of major adverse cardiovascular events in a prospect i ve population based study , with the use of bioempedance analysis , echocardiography , ultrasonography and ECG . PATIENTS AND METHODS The baseline measurements were conducted on 2230 participants ( 1427 women , 803 men with a mean age of 49 ± 15 ) . The follow-up was done 36 months after the baseline admission via telephone call . Major adverse event was defined as mortality or myocardial infa rct ion or stroke . RESULTS Follow-up data was possible in 1495 participants ( 65 % ) . During the follow-up of 36 months ( 4485 patient years ) , 42 major adverse events occurred ( 0.03 % ) . Among them , 16 were death ( 1 stroke , 2 cancer , 13 cardiac related ) , 12 were stroke and 14 were myocardial infa rct ion . Age , body mass index and atrial fibrillation were independent predictors of major adverse events ; AF being the most powerful ( Odds ratio 10.46 ; 95 % confidence interval [ 1.73 - 63.14 ] ; p = 0.010 ) . CONCLUSIONS Age , lower body mass index and atrial fibrillation were independent predictors of major cardiovascular events in our cohort Objectives : Atrial fibrillation has been associated with increased mortality in the general population and mixed population s of critical ill . Atrial fibrillation can also affect patients during post – cardiac arrest care . We sought to assess the prognostic implication s of atrial fibrillation following out-of-hospital cardiac arrest , including relation to the level of targeted temperature management . Design : A post hoc analysis of a prospect i ve r and omized trial . Setting : Thirty-six ICUs . Patients : We included 897 ( 96 % ) of the 939 comatose out-of-hospital cardiac arrest survivors from the targeted temperature management trial ( year , 2010–2013 ) with data on heart rhythm on day 2 . Interventions : Targeted temperature management at 33 ° C or 36 ° C . Measurements and Main Results : Endpoints included cumulative proportion of atrial fibrillation following out-of-hospital cardiac arrest and 180-day all-cause mortality and specific death causes stratified by atrial fibrillation . Atrial fibrillation on day 2 was used as primary endpoint analyses to exclude effects of short-term atrial fibrillation related to resuscitation and initial management . The cumulative proportions of atrial fibrillation were 15 % and 11 % on days 1 and 2 , respectively . Forty-three percent of patients with initial atrial fibrillation the first day were reported with sinus rhythm on day 2 . No difference was found between the groups treated with targeted temperature management at 33 ° C and 36 ° C . Patients affected by atrial fibrillation had significantly higher 180-day mortality ( atrial fibrillation : 66 % vs no-atrial fibrillation : 43 % ; plogrank < 0.0001 and unadjusted hazard ratio , 1.75 [ 1.35–2.30 ] ; p < 0.0001 ) . The association between atrial fibrillation and higher mortality remained significant ( adjusted hazard ratio , 1.34 [ 1.01–1.79 ] ; p < 0.05 ) adjusted for potential confounders . Atrial fibrillation was independently associated with increased risk of cardiovascular death and multiple-organ failure ( adjusted hazard ratio , 2.07 [ 1.39–3.09 ] ; p < 0.001 ) , whereas no association with higher risk of death from cerebral causes was found . Conclusions : Atrial fibrillation was independently associated with higher mortality , primarily driven by cardiovascular causes and multiple-organ failure , and may thus identify a vulnerable sub population . Whether treatment to prevent atrial fibrillation is associated with an improved prognosis remains to be established PURPOSE An obesity paradox , a " paradoxical " decrease in morbidity and mortality with increasing body mass index ( BMI ) , has been shown in patients with heart failure and those undergoing percutaneous coronary intervention . However , whether this phenomenon exists in patients with hypertension and coronary artery disease is not known . METHODS A total of 22,576 hypertensive patients with coronary artery disease ( follow-up 61,835 patient years , mean age 66+/-9.8 years ) were r and omized to a verapamil-SR or atenolol strategy . Dose titration and additional drugs ( tr and olapril and /or hydrochlorothiazide ) were added to achieve target blood pressure control according to the Sixth Joint National Committee on Prevention , Detection , Evaluation , and Treatment of High Blood Pressure targets . Patients were classified into 5 groups according to baseline BMI : less than 20 kg/m2 ( thin ) , 20 to 25 kg/m2 ( normal weight ) , 25 to 30 kg/m2 ( overweight ) , 30 to 35 kg/m2 ( class I obesity ) , and 35 kg/m2 or more ( class II-III obesity ) . The primary outcome was first occurrence of death , nonfatal myocardial infa rct ion , or nonfatal stroke . RESULTS With patients of normal weight ( BMI 20 to<25 kg/m2 ) as the reference group , the risk of primary outcome was lower in the overweight patients ( adjusted hazard ratio [ HR ] 0.77 , 95 % confidence interval [ CI ] , 0.70 - 0.86 , P<.001 ) , class I obese patients ( adjusted HR 0.68 , 95 % CI , 0.59 - 0.78 , P<.001 ) , and class II to III obese patients ( adjusted HR 0.76 , 95 % CI , 0.65 - 0.88 , P < .001 ) . Class I obese patients had the lowest rate of primary outcome and death despite having smaller blood pressure reduction compared with patients of normal weight at 24 months ( -17.5+/-21.9 mm Hg/-9.8+/-12.4 mm Hg vs -20.7+/-23.1 mm Hg /-10.6+/-12.5 mm Hg , P<.001 ) . CONCLUSION In a population with hypertension and coronary artery disease , overweight and obese patients had a decreased risk of primary outcome compared with patients of normal weight , which was driven primarily by a decreased risk of all-cause mortality . Our results further suggest a protective effect of obesity in patients with known cardiovascular disease in concordance with data in patients with heart failure and those undergoing percutaneous coronary intervention OBJECTIVES This study sought to define the relationship between  body mass index ( BMI )  and mortality in heart failure ( HF ) across the world and to identify specific groups in whom BMI may differentially mediate risk . BACKGROUND Obesity is associated with incident HF , but it is paradoxically associated with better prognosis during chronic HF . METHODS We studied 6,142 patients with acute decompensated HF from 12 prospect i ve observational cohorts followed-up across 4 continents . Primary outcome was all-cause mortality . Cox proportional hazards models and net reclassification index described associations of BMI with all-cause mortality . RESULTS Normal-weight patients ( BMI 18.5 to 25 kg/m(2 ) ) were older with more advanced HF and lower cardiometabolic risk . Despite worldwide heterogeneity in clinical features across obesity categories , a higher BMI remained associated with decreased 30-day and 1-year mortality ( 11 % decrease at 30 days ; 9 % decrease at 1 year per 5 kg/m(2 ) ; p < 0.05 ) , after adjustment for clinical risk . The BMI obtained at index admission provided effective 1-year risk reclassification beyond current markers of clinical risk ( net reclassification index 0.119 , p < 0.001 ) . Notably , the " protective " association of BMI with mortality was confined to persons with older age ( > 75 years ; hazard ratio [ HR ] : 0.82 ; p = 0.006 ) , decreased cardiac function ( ejection fraction < 50 % ; HR : 0.85 ; p < 0.001 ) , no diabetes ( HR : 0.86 ; p < 0.001 ) , and de novo HF ( HR : 0.89 ; p = 0.004 ) . CONCLUSIONS A lower BMI is associated with age , disease severity , and a higher risk of death in acute decompensated HF . The " obesity paradox " is confined to older persons , with decreased cardiac function , less cardiometabolic illness , and recent-onset HF , suggesting that aging , HF severity/chronicity , and metabolism may explain the obesity paradox Background Atrial fibrillation ( AF ) is the most common cardiac arrhythmia and is associated with increased risk of stroke and death . Obesity is an independent risk factor for AF , but modifiers of this risk are not well known . We studied the roles of obesity , physical activity , and their interaction in conferring risk of incident AF . Methods and Results The Women 's Health Initiative ( WHI ) Observational Study was a prospect i ve observational study of 93 676 postmenopausal women followed for an average of 11.5 years .  Incident AF was identified using WHI‐ascertained hospitalization records and diagnostic codes from Medicare cl aims . A multivariate Cox 's hazard regression model adjusted for demographic and clinical risk factors was used to evaluate the interaction between obesity and  physical activity and its association with incident AF . After exclusion of women with prevalent AF , incomplete data , or underweight body mass index ( BMI ) , 9792 of the remaining 81 317 women developed AF . Women were , on average , 63.4 years old , 7.8 % were African American , and 3.6 % were Hispanic .  Increased BMI ( hazard ratio [ HR ] , 1.12 per 5‐kg/m2 increase ; 95 % confidence interval [ CI ] , 1.10 to 1.14 ) and  reduced physical activity  ( > 9 vs. 0 metabolic equivalent task hours per week ; HR , 0.90 ; 95 % CI , 0.85 to 0.96 ) were independently associated with higher rates of AF after multivariate adjustment . Higher  levels of physical activity reduced the AF risk conferred by obesity ( interaction P=0.033 ) . Conclusions  Greater physical activity is associated with lower rates of incident AF and modifies the association between obesity and incident AF Background / Aims : The increasing rate of overweight and obesity is alarming . The complications of overweight and obesity at a young age are largely unknown . We aim ed to assess the prevalence of insulin resistance ( IR ) and cardiovascular risk factors among overweight and obese children aged 3 - 5 years . Methods : The study population consisted of 75 children ( 29 overweight , 46 obese ) . We performed anthropometry and bioelectrical impedance analysis as an indicator of body composition . IR was determined by the up date d Homeostasis Model Assessment of Insulin Resistance ( HOMA2-IR ) . Cardiovascular risk factors were defined by the presence of increased serum triglycerides , blood pressure , and HOMA2-IR and by a decreased serum HDL cholesterol . Results : An elevated HOMA2-IR was found in 7.7 % of the children . HOMA2-IR was correlated with body mass index ( r = 0.63 ) , waist circumference ( r = 0.62 ) and percentage body fat ( r = 0.58 ) ( all p < 0.001 ) . Cardiovascular risk factors were present in 6.9 % ( triglycerides ) to 74.3 % ( hypertension ) of the children . Conclusion : IR and cardiovascular risk factors are already evident in many 3- to 5-year-old overweight and obese children . IR is strongly related to body composition AIMS Obesity is a recognized risk factor for  atrial fibrillation ( AF ) , partly because of the association between body mass index ( BMI ) and atrial volume . We aim ed to determine whether other factors relating to body size were related to AF . METHODS AND RESULTS Data were derived from a r and om population sample of 6903 men ( mean age 51.5 years ) who underwent a single midlife evaluation as part of the multifactor Swedish Primary Prevention Study . A total of 1253 men ( 18.2 % ) had a subsequent hospital discharge diagnosis ( principal or secondary ) of AF during a maximum follow-up of 34.3 years . Body surface area ( BSA ) at age 20 ( calculated from recalled weight and measured height ) was strongly related to subsequent AF ( P < 0.0001 ) , as were midlife BMI and weight gain from age 20 to midlife ( P < 0.0001 ) . In a Cox regression model which adjusted for midlife BMI , weight gain and other risk factors , hazard ratios ( HR ) [ 95 % confidence intervals ( CI ) ] for AF for the second , third , and fourth quartile of BSA at age 20 , compared with the lowest quartile , were 1.47 ( 95 % CI , 1.22 - 1.76 ) , 1.66 ( 95 % CI , 1.38 - 2.00 ) , and 2.22 ( 95 % CI , 1.82 - 2.70 ) ( P for trend < 0.0001 ) . CONCLUSION Large body size in youth , in an era when obesity was rare , as well as weight gain from age 20 to midlife , were both independently related to the development of AF . Given the current trends not only for obesity but also for height , a substantial increase in the incidence of AF is likely
Results — An obesity paradox was found for cardiovascular death and all-cause death in the subgroup analyses of r and omized trial cohorts ; however , observational studies fail to show this relationship .
Conclusions — There may be an obesity paradox in atrial fibrillation patients , particularly for all-cause and cardiovascular death outcomes .
An obesity paradox was also evident for stroke/systemic embolic event outcome in NOAC trials , with a treatment effect favoring NOACs over warfarin for both efficacy and safety that was significant only for normal weight patients
Background and Purpose — Obesity is a risk factor for all-cause and cardiovascular death but , despite this , an inverse relationship between overweight or obesity and a better cardiovascular prognosis in long-term follow-up studies has been observed ; this phenomenon , described as obesity paradox , has also been found evident in atrial fibrillation cohorts .
Methods — We performed a systematic review on the relationship between body mass index and major adverse outcomes in atrial fibrillation patients .