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Obesity Paradox in Atrial Fibrillation: Implications for Outcomes and Relationship with Oral Anticoagulant Drugs

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Abstract

In the last 40 years, concern about the obesity epidemic has increased. Data from the current literature highlight a strong relationship between obesity and atrial fibrillation (AF), particularly in relation to an increased risk for incident and recurrent AF. A phenomenon called the “obesity paradox” has emerged: the apparently counterintuitive evidence from epidemiological data indicating that overweight and obese patients may have a better prognosis than healthy-weight patients. A differential impact of oral anticoagulants (OACs) in terms of effectiveness and safety in the various body mass index categories has been postulated, particularly in the comparison between non-vitamin-K antagonist oral anticoagulants and vitamin K antagonists. This review aims to summarize the evidence on the impact of obesity in patients with AF, focusing on descriptions of the obesity paradox and its relationships with OAC treatment.

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Authors and Affiliations

  1. Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy

    Marco Proietti

  2. Geriatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

    Marco Proietti

  3. Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK

    Marco Proietti

  4. Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, 41124, Modena, Italy

    Giuseppe Boriani

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Marco Proietti has conducted consulting activity for Boehringer Ingelheim. Giuseppe Boriani has received small speakers’ fees from Medtronic, Boston, Boehringer, and Bayer, outside of the submitted work.

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Proietti, M., Boriani, G. Obesity Paradox in Atrial Fibrillation: Implications for Outcomes and Relationship with Oral Anticoagulant Drugs. Am J Cardiovasc Drugs 20, 125–137 (2020). https://doi.org/10.1007/s40256-019-00374-0

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