The obesity paradox for outcomes in atrial fibrillation: Evidence from an exposure‐effect analysis of prospective studies

医学 相对风险 内科学 超重 肥胖悖论 体质指数 心房颤动 体重不足 冲程(发动机) 临床终点 前瞻性队列研究 肥胖 心脏病学 置信区间 随机对照试验 机械工程 工程类
作者
Xiao Liu,Linjuan Guo,Kaiwen Xiao,Wengen Zhu,Menglu Liu,Rong Wan,Kui Hong
出处
期刊:Obesity Reviews [Wiley]
卷期号:21 (3) 被引量:43
标识
DOI:10.1111/obr.12970
摘要

Summary 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.
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