Introduction: Several studies have shown obesity to be inversely associated with mortality, the so-called obesity paradox. Although being a major cardiovascular risk factor, patients with morbid obesity are often excluded in HFpEF-related trials. Thus, we aim to evaluate the impact of obesity on major adverse cardiovascular and cerebrovascular events (MACCE) in Hospitalized Geriatric Patients with HFpEF. Methods: We queried the National Inpatient Sample (2019) to identify the geriatric admissions (age ≥65 years) with HFpEF. Comorbidities and outcomes were compared between obese and non-obese patients using relevant ICD-10 codes. Adjusted odds and independent predictors of MACCE with obesity were assessed by multivariable regression controlling for confounders. Results: Of 1743940 geriatric admissions with HFpEF, 430395 (24.7%) were obese [median age 75[70-80], female 63.1%, white 77.1%]. The obese cohort often consisted of relatively younger, female, black patients and had higher rates of obstructive sleep apnea (34.1% vs. 10.9%), diabetes (50.3% vs. 31.3%), hyperlipidemia (62.9% vs. 56.6%), chronic lung disease (48.2% vs 38.4%) and depression (17.3% vs. 13.4%) than non-obese (p<0.001). Comorbidities including hypertension (OR 2.00), peripheral vascular disease (OR 1.19), chronic kidney disease(OR 1.19) (p<0.001), and metastatic cancer (OR 1.20; p<0.019) were independent predictors for MACCE. The obese cohort had significantly lower adjusted odds (OR 0.82) of MACCE (Obesity Paradox) and all-cause mortality (2.9% vs. 4.6%) (p<0.001). They were more frequently discharged with prolonged hospital stays and higher hospital charges compared to non-obese (p<0.001). Conclusions: Obese geriatric HFpEF admissions have significantly lower odds of all-cause mortality and MACCE but higher comorbidity burden and healthcare utilization as compared to non-obese. Hypertension, metastatic cancer, CKD, and PVD were independent risk factors of MACCE.

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Introduction: Cannabis use disorder (CUD) and tobacco use disorder (TUD) are both independent CVD risk factors. However, with the increasing use of recreational cannabis use, the impact of concomitant TUD on major adverse cardiovascular/cerebrovascular events (MACCE) remains unexplored. Hypothesis: Evaluating the impact of concomitant CUD & TUD on MACCE. Methods: We queried 2019's National Inpatient Sample to identify young adults hospitalized with CUD, with vs. without TUD. Baseline demographics, comorbidities, major adverse cardiac events, and the need for revascularization were compared. Multivariable regression analysis was performed, adjusting for confounders to assess the odds of MACCE. Results: Of 539125 patients with CUD, 288260 (53.5%) were TUD+ [median age 31 (25-37)]. TUD+ cohort often had males (60% vs 51.6%), white (58.1% vs 46.8%) patients than TUD- cohort (all p<0.001). The TUD+ cohort showed higher rates of uncomplicated hypertension (15.0% vs 11.6%), alcohol abuse (21.0% vs 12.9%) but lower rates of obesity (9.2% vs. 11.6%), diabetes with chronic complications (4.5% vs. 5.4%), complicated hypertension (3.7% vs 4.4%) and metastatic cancer (0.2% vs. 0.5%) (all p<0.001). After adjusting for covariates, the TUD+ arm had significantly higher odds of acute MI (OR:1.37), Acute PE (OR:1.46), Type 1-DM (OR:1.66), PCI (OR:1.78), CABG (OR:2.62) but lower odds of all-cause mortality (OR:0.55), cardiac arrest including VF (OR:0.59), AF (OR:0.67) and dysrhythmia (OR:0.75) (all p<0.001) [Fig. 1]. The TUD+ cohort incurred lower hospital charges than TUD- cohort (p<0.001). No statistical significance was observed in the odds of stroke and MACCE. Conclusions: Concomitant tobacco & cannabis use had higher odds of Acute MI, PE, PCI and CABG but, interestingly, lower odds of all-cause mortality, dysrhythmia, AF and cardiac arrest including VF. The association between cannabis use and concomitant tobacco use on MACCE needs to be further studied.