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Clinical Studies and Practice

Presence of obesity is associated with lower mortality in elderly patients with implantable cardioverter defibrillator

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Abstract

Background:

Higher body mass index (BMI) is associated with greater prevalence of cardiovascular risk factors, yet an inverse relationship between obesity and survival after cardiovascular events has been described. It is unclear whether a similar relationship exists for patients with implantable cardioverter defibrillators (ICDs) at high risk for mortality. We aimed to assess the impact of BMI on mortality and cardiovascular hospitalization in patients with ICD.

Methods:

Patients who underwent ICD implantation in 2010–2011 were divided into normal (<25 kg m−2), overweight (25–29.9 kg m−2) and obese (⩾30 kg m−2) groups based on BMI. Clinical parameters were compared and long-term outcomes were determined using χ2 test, Wilcoxon's rank-sum test, logistic regression models and Kaplan–Meier curves.

Results:

Of 904 patients (mean age 67±13 years), 26% had normal BMI, 32% were overweight and 42% were obese. No significant baseline differences in ventricular ejection fraction, ICD for primary or secondary prevention, history of heart failure, syncope or cardiac arrest existed. Despite a greater prevalence of diabetes, hypertension and prior myocardial infarction, the obese and overweight groups had lower mortality (10.1% and 7.9%, respectively) than the normal group (22.9%, P<0.001). On multivariate logistic regression, BMI in the obese and overweight range (odds ratio (OR): 0.35; 95% confidence interval (CI): 0.21–0.58 and OR: 0.25; 95% CI: 0.13–0.40, respectively) was protective against mortality, whereas history of diabetes (OR: 2.01; 95% CI: 1.30–3.09), myocardial infarction (OR: 1.76; 95% CI: 1.11–2.80), heart failure (OR: 3.88; 95% CI: 1.56–9.66), stroke (OR: 3.19; 95% CI: 1.63–6.23) and history of cardiac arrest (OR: 2.65; 95% CI: 1.37–5.15) were independent risk factors for higher mortality.

Conclusions:

A paradoxical relationship between BMI and mortality risk is present in elderly patients with ICD at high risk of sudden death with a lower mortality in obese or overweight patients than in those with normal BMI.

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Acknowledgements

We are grateful to Jennifer Pfaff and Susan Nord of Aurora Cardiovascular Services for editorial preparation of the manuscript and Aurora Research Institute and Wisconsin bariatric surgery unit staff, particularly Sara Rudolf. Part of Dr Jahnagir’s effort was supported by NHLBI/NIH grant support and Intramural Research Awards.

Author contributions

AJ conceived and designed the study, interpreted results, drafted and gave final approval to the manuscript. MM, MS and SS acquired and analyzed data, assisted with drafting manuscript and AhJ helped with preparing table and figures; TM performed biostatistical analysis; RS acquired data; IC, VN, AD, AB, IN, JS, and AJT assisted with data collection and manuscript revision. All authors approved the final version of the manuscript.

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Authors and Affiliations

  1. Center for Integrative Research on Cardiovascular Aging (CIRCA), Aurora Research Institute, Aurora Health Care, Aurora University of Wisconsin Medical Group, Milwaukee, WI, USA

    A Jahangir, M Mirza, M Shahreyar, S Sultan & A J Tajik

  2. Aurora Cardiovascular Services, Aurora Sinai/ Aurora St Luke’s Medical Centers, Milwaukee, WI, USA

    A Jahangir, T Mengesha, R Shearer, I Choudhuri, V Nangia, A Dhala, A Bhatia, I Niazi, J Sra & A J Tajik

  3. Aurora Health Care, Milwaukee, WI, USA

    A Jahangir

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  1. A Jahangir
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Correspondence to A Jahangir.

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Jahangir, A., Mirza, M., Shahreyar, M. et al. Presence of obesity is associated with lower mortality in elderly patients with implantable cardioverter defibrillator. Int J Obes 42, 169–174 (2018). https://doi.org/10.1038/ijo.2017.211

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  • DOI: https://doi.org/10.1038/ijo.2017.211

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