Association between Body Mass Index and Clinical Outcomes in Patients with Non-valvular Atrial Fibrillation Receiving Direct Oral Anticoagulants: A New Piece of Evidence on the Obesity Paradox from China

• Published in: Cardiovascular drugs and therapy Vol. 37; no. 4; pp. 715 - 727
• Main Authors: Wu, Shuyi, Huang, Nianxu, Chen, Xia, Jiang, Shaojun, Zhang, Wang, Hu, Wei, Su, Jun, Dai, Hengfen, Gu, Ping, Huang, Xiaohong, Du, Xiaoming, Li, Ruijuan, Zheng, Qiaowei, Lin, Xiangsheng, Zhang, Yanxia, Zou, Lang, Liu, Yuxin, Zhang, Min, Liu, Xiumei, Zhu, Zhu, Sun, Jianjun, Hong, Shanshan, She, Weibin, Zhang, Jinhua
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.08.2023; Springer Nature B.V
• Subjects: Administration, Oral; Anticoagulants; Anticoagulants - adverse effects; Atrial Fibrillation - diagnosis; Atrial Fibrillation - drug therapy; Atrial Fibrillation - epidemiology; Bleeding; Body mass; Body Mass Index; Body size; Body weight; Cardiac arrhythmia; Cardiology; Clinical outcomes; Cohort Studies; Death; Fibrillation; Hemorrhage - chemically induced; Hemorrhage - epidemiology; Humans; Medicine; Medicine & Public Health; Mortality; Obesity; Obesity - diagnosis; Obesity - epidemiology; Obesity Paradox; Original Article; Overweight; Overweight - complications; Overweight - drug therapy; Overweight - epidemiology; Patients; Stroke; Thinness - complications; Thinness - diagnosis; Thinness - epidemiology; Thromboembolism; Thrombosis; Underweight; China; Body mass index; Direct oral anticoagulation; Thrombosis; Atrial fibrillation; Bleeding
• ISSN: 0920-3206; 1573-7241
• DOI: 10.1007/s10557-022-07332-0

Purpose We conducted a multicenter real-world study in China to assess the association between body mass index (BMI) and clinical outcomes in patients with atrial fibrillation (AF) taking direct oral anticoagulants (DOACs). Method This is a retrospective multicenter cohort study conducted in 15 centers in China. We collected demographic information through the hospital information system and obtained clinical events through follow-up visits to patients or relatives. Clinical outcomes include major, minor, total bleeding, thromboembolism, and all-cause death. Result A total of 6164 patients with non-valvular AF (NVAF) were included in this study. The incidence of major bleeding in patients with NVAF differed significantly by BMI category ( P < 0.001), with 5.2% in the underweight group, 2.6% in the normal group, 1.4% in the overweight group, 1.1% in the obese I group, and 1.3% in the obese II group. There was no significant difference in minor, total bleeding, and thrombosis in the five groups ( P = 0.493; P = 0.172; P = 0.663). All-cause death was significantly different among the five groups ( P < 0.001), with 8.9% in the underweight group, 6.3% in the normal group, 4.8% in the overweight group, 2.2% in the obese I group, and 0.4% in the obese II group. High BMI was negatively associated with major bleeding (OR = 0.353, 95% CI 0.205–0.608), total bleeding (OR = 0.664, 95% CI 0.445–0.991), and all-cause death (OR = 0.370, 95% CI 0.260–0.527). Conclusion In patients with NVAF treated with DOACs, higher BMI was associated with lower major bleeding and better survival. BMI was a negative correlate of total bleeding, but not minor bleeding and thrombosis.