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Research Paper|Volume 16, Issue 14|pp 11359—11372

Effect of body mass index on mortality for diabetic patients with aortic stenosis

Kai-Chun Chang1, Li-Ting Ho1,2, Kuan-Chih Huang3, Jung-Chi Hsu4, David Te-Wei Kuan1, Ting-Tse Lin1,2, Jen-Kuang Lee1,2, Yen-Yun Yang5, Shu-Lin Chuang5, Lian-Yu Lin1,2
  • 1Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
  • 2Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
  • 3Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
  • 4Department of Internal Medicine, National Taiwan University Hospital Jinshan Branch, New Taipei City, Taiwan
  • 5Integrative Medical Database Center, Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
* Equal contribution
Received: February 6, 2024Accepted: June 7, 2024Published: July 24, 2024
https://doi.org/10.18632/aging.206018

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.