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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

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Abstract

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.

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Data Availability

All data relevant to the study are included in the article as supplementary information.

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Acknowledgement

All the authors are grateful to Meina Lv and Tingting Wu for their contribution to the data collation.

Funding

No specific funding was necessary to conduct this study.

Author information

Author notes

  1. Shuyi Wu, Nianxu Huang and Xia Chen contributed equally to this work.

Authors and Affiliations

  1. Department of Pharmacy, Fujian Medical University Union Hospital, #29 Xinquan Road, Fuzhou, 350001, Fujian, China

    Shuyi Wu, Shaojun Jiang & Jinhua Zhang

  2. Department of Pharmacy, Taikang Tongji(Wuhan) Hospital, Wuhan, 430000, China

    Nianxu Huang

  3. Department of Pharmacy, Fuling Hospital of Chongqing University, Chongqing, 408099, China

    Xia Chen

  4. Department of Pharmacy, The First People’s Hospital of Changde City, Changde City, 415000, Hunan, China

    Wang Zhang

  5. Department of Pharmacy, Xinyang Central Hospital, Xinyang Hospital Affiliated to Zhengzhou University, Zhengzhou, 464000, Henan, China

    Wei Hu

  6. Department of Pharmacy, The First Affiliated Hospital of Bengbu Medical College, Anhui, 233004, China

    Jun Su

  7. Department of Pharmacy, Affiliated Fuzhou First Hospital of Fujian Medical University, Fujian, 350009, China

    Hengfen Dai

  8. Department of Pharmacy, Suining Central Hospital, Suining, 629000, Sichuan, China

    Ping Gu

  9. Department of Pharmacy, Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, 363000, China

    Xiaohong Huang

  10. Department of Pharmacy, Shengjing Hospital of China Medical University, Shenyang, 110004, China

    Xiaoming Du

  11. Department of Pharmacy, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Shanxi, 030032, China

    Ruijuan Li

  12. Department of Pharmacy, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710061, Shaanxi, China

    Qiaowei Zheng

  13. Department of Pharmacy, Pingtan County General Laboratory Area Hospital, Fujian, 350400, China

    Xiangsheng Lin

  14. Department of Pharmacy, The First Affiliated Hospital of Jiamusi University, Heilongjiang, 154002, China

    Yanxia Zhang

  15. Department of Pharmacy, Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China

    Lang Zou

  16. Department of Pharmacy, Huaihe Hospital of Henan University, Henan, 475000, China

    Yuxin Liu

  17. Department of Pharmacy, Affiliated Qingdao Third People’s Hospital, Qingdao University, Shandong, 266041, China

    Min Zhang

  18. Department of Pharmacy, People’s Hospital of He’nan University of Chinese Medicine (People’s Hospital of Zhengzhou), Zhengzhou, 450003, China

    Xiumei Liu

  19. Department of Pharmacy, The Second Affiliated Hospital of Soochow University, Jiangsu, 215004, China

    Zhu Zhu

  20. Department of Pharmacy, Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, 010050, China

    Jianjun Sun

  21. Department of Pharmacy, Quanzhou First Hospital, Fujian, 362000, China

    Shanshan Hong

  22. Department of Medical Administration, Dongguan Kanghua Hospital, Guangdong, 523000, China

    Weibin She

Authors
  1. Shuyi Wu
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  2. Nianxu Huang
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  3. Xia Chen
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  4. Shaojun Jiang
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  5. Wang Zhang
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  6. Wei Hu
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  7. Jun Su
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  8. Hengfen Dai
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  9. Ping Gu
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  10. Xiaohong Huang
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  11. Xiaoming Du
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  12. Ruijuan Li
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  16. Lang Zou
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  18. Min Zhang
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  20. Zhu Zhu
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  24. Jinhua Zhang
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Contributions

JZ initiated the study. JZ, XC, NH, HD, WZ, XH, PG, XL, XD, QZ, YL, XL, RL, MZ, and ZZ collected and entered the data. XC and SJ performed data collation. SW and NH performed data extraction and analyses. SW drafted the first version of the manuscript. JZ ,SW, NH, XC, WH, and JS critically reviewed the manuscript and revised it. WH, JS, and YZ worked on data validation. LZ, JS, SH, and WS performed the graphical revisions. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jinhua Zhang.

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Ethical Approval

The study complies with the Declaration of Helsinki and was authorized by The Ethics Committee of Fujian Medical University Union Hospital.

Informed Consent

The requirement for patient consent was waived due to its retrospective nature.

Conflict of Interest

The authors declare that they have no conflicts of interest.

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Wu, S., Huang, N., Chen, X. et al. 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. Cardiovasc Drugs Ther 37, 715–727 (2023). https://doi.org/10.1007/s10557-022-07332-0

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