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 .
Obesity and outcomes among patients with established atrial fibrillation.
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
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 .