Research Paper Advance Articles
Effect of body mass index on mortality for diabetic patients with aortic stenosis
- 1 Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- 2 Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- 3 Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
- 4 Department of Internal Medicine, National Taiwan University Hospital Jinshan Branch, New Taipei City, Taiwan
- 5 Integrative Medical Database Center, Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
Received: February 6, 2024 Accepted: June 7, 2024 Published: July 24, 2024
https://doi.org/10.18632/aging.206018How to Cite
Copyright: © 2024 Chang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Background: Several studies suggest an “obesity paradox,” associating obesity with better cardiovascular outcomes in patients with type 2 diabetes mellitus (DM) or aortic stenosis (AS) compared to normal or underweight individuals. This study explores the impact of body mass index (BMI) on diabetic patients with AS.Methods: Between 2014 and 2019, patients with DM who underwent echocardiography were analyzed. Outcomes included all-cause mortality, cardiovascular, and non-cardiovascular death. Patients were categorized as underweight, normal weight, or obese based on BMI (<18.5, 18.5 to 27, and >27 kg/m2, respectively).
Results: Among 74,835 DM patients, 734 had AS. Normal weight comprised 65.5% (n=481), underweight 4.1% (N=30), and 30.4% were obese. Over a 6-year follow-up, underweight patients had significantly higher all-cause mortality (HR 1.96, 95% CI 1.22 – 3.14, p = 0.005), while obese patients had significantly lower mortality (HR 0.79, 95% CI 0.68 - 0.91, p=0.001) compared to the normal group. Regarding etiologies, underweight patients had a higher risk of non-cardiovascular death (HR 2.47, 95% CI 1.44-4.25, p = 0.001), while obese patients had a lower risk of cardiovascular death (HR 0.66, 95% CI 0.50-0.86, p=0.003). Subgroup analysis showed a consistent trend without significant interaction.
Conclusions: BMI significantly impacts mortality in DM patients with AS. Being underweight is associated with worse non-cardiovascular death, while obesity is linked to improved cardiovascular death outcomes.
Abbreviations
aHR: adjusted hazard ratio; AS: aortic stenosis; BMI: body mass index; CAD: coronary artery disease; CI: confidence interval; DM: diabetes mellitus; EHRs: electronic health records; HTN: hypertension; IQR: interquartile range; LA: left atrium; LVED: left ventricle ejection fraction; LVIDd: left ventricle internal dimension in end-diastole; LVIDs: left ventricle internal dimension in end systole; LVM: left ventricle mass; NTUH: National Taiwan University Hospital; NTUH-iMD: National Taiwan University Hospital integrated Medical Database; PAOD: peripheral arterial occlusive disease; SAVR: surgical aortic-valve replacement; TAVR: transcatheter aortic-valve replacement; TRPG: tricuspid regurgitation peak gradient.