Obesity paradox on outcome in atrial fibrillation maintained even considering the prognostic influence of biomarkers: insights from the ARISTOTLE trial

Abstract

ObjectiveWe investigated the association between obesity and biomarkers indicating cardiac or renal dysfunction or inflammation and their interaction with obesity and outcomes.MethodsA total of 14 753 patients in the Apixaban for Reduction In STroke and Other ThromboemboLic Events in Atrial Fibrillation (ARISTOTLE) trial provided plasma samples at randomisation to apixaban or warfarin. Median follow-up was 1.9 years. Body Mass Index (BMI) was measured at baseline and categorised as normal, 18.5–25 kg/m2; overweight, >25 to <30 kg/m2; and obese, ≥30 kg/m2. We analysed the biomarkers high-sensitivity C reactive protein (hs-CRP), interleukin 6 (IL-6), growth differentiation factor-15 (GDF-15), troponin T and N-terminal B-type natriuretic peptide (NT-pro-BNP). Outcomes included stroke/systemic embolism (SE), myocardial infarction (MI), composite (stroke/SE, MI, or all-cause mortality), all-cause and cardiac mortality, and major bleeding.ResultsCompared with normal BMI, obese patients had significantly higher levels of hs-CRP and IL-6 and lower levels of GDF-15, troponin T and NT-pro-BNP. In multivariable analyses, higher compared with normal BMI was associated with a lower risk of all-cause mortality (overweight: HR 0.73 (95% CI 0.63 to 0.86); obese: 0.67 (0.56 to 0.80), p<0.0001), cardiac death (overweight: HR 0.74 (95% CI 0.60 to 0.93); obese: 0.71 (0.56 to 0.92), p=0.01) and composite endpoint (overweight: 0.80 (0.70 to 0.92); obese: 0.72 (0.62 to 0.84), p<0.0001).ConclusionsRegardless of biomarkers indicating inflammation or cardiac or renal dysfunction, obesity was independently associated with an improved survival in anticoagulated patients with AF.Trial registration numberNCT00412984.

Utilization and in‐hospital complications of catheter ablation for atrial fibrillation in patients with obesity and morbid obesity

“… 2 , 3 On the contrary, several studies have pointed out the obesity paradox effect owing to the favorable cardiovascular outcomes observed on anticoagulated AF patients with obesity compared to nonobese. 4 Furthermore, one study suggested weight loss in obese patients who underwent AF ablation, surprisingly, did not improve AF recurrence rates. 5 …”

The Link Between Atrial Fibrillation and Obesity

“…A recent study on apixaban seems to show that, compared to warfarin in obese or overweight patients, there is less SSE without risk of bleeding [15].…”

Particularities of arrhythmias and obesity in heart failure

“…Also, a normal BMI may be due to several pathological catabolic conditions 26 . In the Aristotle study, the presence of obesity was shown to be associated with a better survival in patients with atrial fi brillation effi ciently anticoagulated, regardless of the infl ammation biomarkers values or the presence of renal impairment 27 .…”