Presence of obesity is associated with lower mortality in elderly patients with implantable cardioverter defibrillator

Jahangir, Arshad; Mirza, Mahek; Shahreyar, Muhammad; Mengesha, Tadele; Shearer, Robyn; Sultan, Sulaiman; Choudhuri, Indrajit; Nangia, Vikram; Dhala, Anwer; Bhatia, Atul; Niazi, Imran Khan; Sra, Jasbír; Tajik, A. Jamil

doi:10.1038/ijo.2017.211

Cited by 15 publications

(23 citation statements)

References 45 publications

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“…Some previous studies also described an improved long‐term survival after CRT placement or ICD implantation, or combined CRT‐D placement, whereas other studies found similar outcomes among CRT in obese and non‐obese HF patients who received CRT therapy . Our study differs from prior ones in many aspects including the length of follow‐up (< 3 years), examination of CRT or ICD alone outcomes separately, population with inclusion of a limited number of patients (thus lacking the depth and diversity of our study population with respect to race, age or sex), or younger patients (< 65 years of age) than those included in our study (≥ 65 years) …”

Section: Discussionmentioning

confidence: 69%

“…Whether such an association is also observed in patients who receive CRT with defibrillator (CRT‐D) implantation is unclear. Some studies have described an improved long‐term survival among obese individuals who received CRT, whereas other studies found similar outcomes after CRT in obese and non‐obese patients . Other studies described lower death rates associated with a BMI > 25 kg/m 2 or an association of underweight or weight loss with higher death rates .…”

Section: Introductionmentioning

confidence: 99%

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Body mass index and outcomes of cardiac resynchronization with implantable cardioverter‐defibrillator therapy in older patients with heart failure

Echouffo‐Tcheugui

Bao

Curtis

et al. 2019

European J of Heart Fail

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Aims To assess the association of body mass index (BMI) with heart failure (HF) outcomes after cardiac resynchronization therapy with defibrillator (CRT‐D) implantation. Methods and results Medicare beneficiaries with HF aged ≥ 65 years (n = 18 922) undergoing first‐time CRT‐D from the National Cardiovascular Data Registry (NCDR) Implantable Cardioverter‐Defibrillator Registry between 2010 and 2013, were followed for 3 years post‐implantation. Survival curves and covariate adjusted hazard ratio (aHR) or odds ratio were used to assess the risks for death, readmission, and device‐related complications by BMI status. Of 18 922 HF patients receiving CRT‐D, 5265 (27.8%) were normal weight, 6896 (37%) were overweight, 6318 (33.4%) were obese, and 353 (1.8%) were underweight. Compared to those of normal weight (BMI 18.5–24.9 kg/m2), underweight patients had a higher 3‐year post‐device implantation risk of death [aHR: 1.34 (95% confidence interval 1.09–1.65); P < 0.001] and of readmission [sub‐aHR: 1.25 (1.09–1.42); P < 0.001]. The corresponding 3‐year aHRs for death were 0.83 (0.77–0.89) for overweight, 0.74 (0.67–0.82) for obesity class I (BMI 30–34.9 kg/m2), 0.78 (0.68–0.90) for obesity class II (BMI 35–39.9 kg/m2), and 0.75 (0.60–0.93) for obesity class III (BMI ≥ 40 kg/m2, P for all categories < 0.001). Individuals with class III obesity had a higher risk of readmission [sub‐aHR: 1.17 (1.06–1.30)]. There were no differences in rates of device‐related complications within 90 days across BMI categories. Conclusion Most elderly patients with HF receiving CRT‐D were overweight or obese. While being underweight was associated with greater risks of death and hospitalization, overweight and obese patients were at lower risk of death after CRT‐D.

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Section: Discussionmentioning

confidence: 69%

Section: Introductionmentioning

confidence: 99%

Body mass index and outcomes of cardiac resynchronization with implantable cardioverter‐defibrillator therapy in older patients with heart failure

Echouffo‐Tcheugui

Bao

Curtis

et al. 2019

European J of Heart Fail

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“…Sarcopenic obesity is a high-risk elderly syndrome that is mainly observed in elderly populations at risk of synergistic complications related to sarcopenia and obesity. Previously, sarcopenic obesity has been associated with a relatively higher risk of incident disability, comorbidities, and mortality [ 34 ]. Thus, introducing dietary interventions to optimize health status, especially for sarcopenic obese elderly persons in Korea, should be considered.…”

Section: Discussionmentioning

confidence: 99%

Relationship between diet quality and sarcopenia in elderly Koreans: 2008–2011 Korea National Health and Nutrition Examination Survey

Kim

Chung

et al. 2020

Nutr Res Pract

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BACKGROUND/OBJECTIVES Given the increasing proportion of the Korean population that is aged 65 years and older, the present study analyzed the relationship between diet quality and sarcopenia in elderly persons by using data from the 2008–2011 Korea National Health and Nutrition Examination Survey (KNHANES). SUBJECTS/METHODS Data for 3,373 persons aged 65 years and over (men: 1,455, 43.1%) were selected from the 2008–2011 KNHANES. Sarcopenia assessments are based on a formula that divides a subject's appendicular skeletal muscle mass (ASM) by their weight (wt) and multiplies that result by 100 ([ASM/wt] × 100). Sarcopenia is present if the subject's result was less than one standard deviation (SD) below the sex-specific mean for a young reference group. For evaluation of diet quality, data obtained via the 24-hour recall method were used to calculate the Diet Quality Index for Koreans (DQI-K). A general linear model was applied in order to analyze general information and nutritional intake according to sarcopenia status. For analysis of the relationship between diet quality and sarcopenia, a binominal logistic regression analysis was undertaken. RESULTS The sarcopenia prevalence rate among the study subjects aged 65 years and over was 37.6%. The DQI-K of those without sarcopenia was 3.33 ± 0.04 points, while that of those with sarcopenia was 3.45 ± 0.04 points ( P < 0.05). The relationship between diet quality and sarcopenia revealed that subjects aged 75 and older had a poor diet quality, and their odds ratio (OR) of sarcopenia presence was significantly higher (OR: 1.807, 95% confidence interval: 1.003–3.254, P < 0.05). CONCLUSIONS This study revealed that poor diet quality was related to sarcopenia presence in Koreans aged 75 and older. In order to improve the diet quality of the elderly (aged 75 and older), it is necessary to develop dietary improvement guidelines.

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“…(22,23). Although a paradoxical relationship between obesity (BMI) and mortality risk was also shown in elderly ICD-indicated patients at high risk of sudden death, the major cause of death was heart failure in this population (24).…”

Section: Discussionmentioning

confidence: 86%

Paradoxical Prognostic Implications of Visceral Adiposity for Lethal Cardiac Events in Association with Impaired Cardiac Sympathetic Innervation in Chronic Heart Failure

Doi

Nakata

Noto

et al. 2020

Annals of Nuclear Cardiology

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Background: Obesity increases the risk for development of heart failure (HF) but, when present is likely to be related to better outcomes in patients with HF. This study aimed to clarify the paradoxical prognostic values of visceral obesity in association with cardiac sympathetic function in HF patients. Methods and Results: A total of 653 consecutive patients with systolic HF who underwent visceral adiposity area (VAA) measurements using a computed tomographic technique were divided into 3 groups: VAA 1, area <80 cm 2 ; VAA 2, area 80-140 cm 2 ; VAA 3, area >140 cm 2. Sympathetic innervation was quantified by 123 I-MIBG cardiac activity. Patients were followed up for an average of 22 months with a primary endpoint of lethal cardiac events (CE). The CE group (n=200) had a lower late heart-to mediastinum ratio (HMR) and a smaller VAA than those in the non-CE group. Rates of overall CE/HF death were inversely correlated with VAA: 39.2%/±6.2% for VAA 1, 27.4%±19.9% for VAA 2 and 24.1%±15.3% for VAA 3. In addition to sudden cardiac death rate, lethal arrhythmic event rate increased in association with visceral fat obesity: 3.0% for VAA 1, 7.5% for VAA 2 and 8.8% for VAA 3. Late HMR identified high-risk sub-populations in each group. Conclusion: Visceral obesity has paradoxical prognostic implications in terms of HF mortality and lethal arrhythmic/sudden cardiac death events. Cardiac sympathetic denervation and quantitative visceral adiposity are synergistically associated with overall cardiac mortality, contributing to better risk stratification of HF patients.

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Presence of obesity is associated with lower mortality in elderly patients with implantable cardioverter defibrillator

Abstract: A paradoxical relationship between BMI and mortality risk is present in elderly patients with ICD at high risk of sudden death with a lower mortality in obese or overweight patients than in those with normal BMI.

Cited by 15 publications

References 45 publications

Body mass index and outcomes of cardiac resynchronization with implantable cardioverter‐defibrillator therapy in older patients with heart failure

Body mass index and outcomes of cardiac resynchronization with implantable cardioverter‐defibrillator therapy in older patients with heart failure

Relationship between diet quality and sarcopenia in elderly Koreans: 2008–2011 Korea National Health and Nutrition Examination Survey

Paradoxical Prognostic Implications of Visceral Adiposity for Lethal Cardiac Events in Association with Impaired Cardiac Sympathetic Innervation in Chronic Heart Failure

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