Obesity, overweight worsen health-related quality of life in patients with PAH

Obesity and overweight were associated with worse health-related quality of life and increased risk for hospitalization in patients with pulmonary arterial hypertension, researchers reported in Annals of the American Thoracic Society.

Researchers analyzed 767 adults with PAH (mean age, 57 years; 75% women; 68% non-Hispanic white) from the prospective, multicenter Pulmonary Hypertension Association Registry. Median follow-up duration of patients in the registry was 527 days. Forty percent had obesity and 33% overweight. Patients with obesity were more likely to have idiopathic PAH. The researchers examined the relationship between weight categories and health-related quality of life, hospitalization and transplant-free survival.

Patients with overweight and obesity had worse health-related quality of life that persisted over time (P < .001), according to scores on the Short Form-12 and emPHasis-10.

Researchers observed a trend toward increased incidence of hospitalization among patients with overweight (incidence rate ratio [IRR] = 1.34; 95% CI, 0.94-1.92) and obesity (IRR = 1.33; 95% CI, 0.93-1.89) compared with patients with normal weight.

The researchers reported lower risk for transplant or death among patients with overweight (HR = 0.45; 95% CI, 0.25-0.8) and obesity (HR = 0.39; 95% CI, 0.22-0.7) compared with patients with normal weight.

“Overweight and obese patients had a trend towards increased incidence rates for hospitalizations when compared to normal-weight individuals,” Jeff Min, MD, from the department of medicine at Perelman School of Medicine at the University of Pennsylvania, Philadelphia, and colleagues wrote. “Despite this, overweight and obese individuals had better overall transplant-free survival as compared to the normal-weight patients, consistent with an ‘obesity paradox’ in PAH.”

According to the researchers, an obese body habitus limits the ability to assess volume status and may hide lower-extremity edema or ascites. Due to this, they hypothesize that patients with overweight and obesity with PAH may be more difficult to manage as outpatients, which may result in more hospitalizations.

“Further ‘deep phenotyping’ of patients’ fat distribution and cardiometabolic risk profiles is warranted to understand the underlying mechanism for these findings,” the researchers wrote. “Future interventions in PAH should address the specific needs of overweight and obese patients and may include support groups and targeted strategies for weight management.”