Obesity linked to lower mortality risk among patients with venous thromboembolism
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Patients with venous thromboembolism and obesity had a lower mortality risk than those with normal BMI, according to a study published in Journal of Thrombosis and Haemostasis.
In addition, underweight patients had the highest risk for mortality and major bleeding.
The results of GARFIELD-VTE, a prospective, noninterventional study, confirmed what researchers called the “obesity paradox.”
“This is surprising because obesity has been identified as a minor persistent risk factor for recurrent VTE,” Jeffrey I. Weitz, MD, professor of medicine and biochemistry and biosciences at McMaster University in Hamilton, Ontario, Canada, and executive director of the Thrombosis and Atherosclerosis Research Institute, told Healio. “The findings that major bleeding and mortality were highest in underweight patients even after adjustment for cancer were surprising.”
Weitz and colleagues initiated the study to gain more information on the influence of BMI on clinical outcomes of patients with VTE.
The analysis included 10,869 patients with objectively confirmed VTE enrolled in the GARFIELD-VTE registry from 415 sites across 28 countries between May 2014 and January 2017. Researchers grouped patients according to BMI as:
- underweight, defined at less than 18.5 kg/m2 (n = 214; median BMI, 17.4 kg/m2; 60.7% women; median age, 61.9 years; 50.7% Asian, 33.2% white, 12.2% Black);
- normal, defined as 18.5 kg/m2 to 24.9 kg/m2 (n = 2,866; median BMI, 22.9 kg/m2; 51.5% women; median age, 59.6 years; 32.1% Asian, 57.9% white, 4.8% Black);
- overweight, defined as 25 kg/m2 to 29.9 kg/m2 (n = 3,326; median BMI, 27.4 kg/m2; 41.3% women; median age, 61.2 years; 17.3% Asian, 73.1% white, 3.5% Black); and
- obese, defined as 30 kg/m2 or higher (n = 3,073; median BMI, 34 kg/m2; 56.2% women; median age, 58.9 years; 7.7% Asian, 77.4% white, 6.2% Black).
Weitz and colleagues evaluated clinical outcomes including all-cause mortality, recurrent VTE and major bleeding, with the earliest event for each outcome considered for analysis.
Results showed that although the groups had comparable incidence of recurrent VTE, patients with overweight or obesity had a lower risk of all-cause mortality than those with normal BMI after 24 months (overweight, adjusted HR [aHR] = 0.75; 95% CI, 0.63-0.89; obese, aHR = 0.59; 95% CI, 0.49-0.72). Additionally, underweight patients more often experienced major bleeding (adjusted HR = 2.45; 95% CI, 1.41-4.26) and all-cause mortality (adjusted HR, 1.9; 95% CI, 1.43-2.53) than patients with normal BMI.
Weitz and colleagues also reported that:
- patients with obesity, when compared with those with normal BMI, appeared more likely to be white, have been treated in the outpatient setting (30.4% vs. 23.1%) and have had previous VTE (17.5% vs. 11.7%);
- patients with active cancer tended to have lower BMI (30.4% underweight, 13.5% normal, 9.4% overweight, 7% obese);
- patients with overweight (16.7%) and obesity (14.4%) received parenteral therapy alone less often at baseline than patients with underweight (30.8%) or normal BMI (21.6%); and
- patients with obesity more commonly remained on anticoagulants for 2 or more years compared with those who had normal BMI (52.3% vs. 37.7%).
“Current anticoagulation practices vary according to BMI,” Weitz said. “Major bleeding was highest in underweight patients, suggesting that further research is needed to determine the optimal treatment regimens for patients with extreme BMIs.”
For more information:
Jeffrey I. Weitz, MD, can be reached at Thrombosis and Atherosclerosis Research Institute, 237 Barton St. East, Room C5-123, Hamilton, ON L8L 2X2, Canada; email: weitzj@taari.ca.
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