Issue: February 2013
January 11, 2013
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'Obesity paradox' observed in patients after TAVR

Issue: February 2013
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The “obesity paradox,” previously reported in patients after PCI, may also occur in those who have undergone transcatheter aortic valve replacement, according to study findings. Specifically, obese patients who underwent transcatheter aortic valve replacement had a greater incidence of minor, but not major, perioperative complications and lower 30-day mortality.

Perspective from Srinivas Iyengar, MD, FACC

In all, researchers studied 940 patients who underwent TAVR, of whom 25 (2.7%) were underweight, 384 (40.9%) normal weight, 372 (39.6%) overweight and 159 (16.9%) obese.

Obese patients had a greater incidence than normal weight and overweight patients of minor stroke (1.3% vs. 0 [normal] and 0.3% [overweight]; P=.03), minor vascular complications (15.7% vs. 9.1% [normal] and 11.6% [overweight]; P=.028) and acute kidney injury stage I (23.3% vs. 10.7% [normal] and 16.1% [overweight]; P<.001).

There was no association between BMI and 30-day and 1-year mortality when using it as a categorical variable. As a continuous variable, BMI was associated with a lower risk for mortality at 30 days (OR=0.93; 95% CI, 0.86-0.98) but had no effect on survival after discharge (HR=1.01; 95% CI, 0.96-1.07), leading researchers to suggest that the findings underscore the obesity paradox in patients undergoing TAVR. Furthermore, every BMI increase in 1 kg/m2 was associated with a 7% mortality reduction.

The researchers also said obese patients were younger than the nonobese patients and had a greater prevalence of preserved ventricular and renal function.

“The combination of these characteristics might have contributed and, even explain, the lower rate of all-cause mortality at 30 days, providing a possible explanation for the apparent paradox,” they wrote.

Disclosure: Van der Boon reports no relevant financial disclosures.