Volume 47, Issue 11 pp. 1464-1473

DEVICES

Association between obesity paradox in the all-cause mortality among patients with cardiac resynchronization therapy device

Phuuwadith Wattanachayakul MD,

Corresponding Author

Phuuwadith Wattanachayakul MD

[email protected]

orcid.org/0000-0003-0086-5269

Department of Medicine, Jefferson Einstein Hospital, Philadelphia, Pennsylvania, USA

Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA

Correspondence

Phuuwadith Wattanachayakul, MD, Department of Medicine, Jefferson Einstein Hospital, Philadelphia, PA 19141, USA.

Email: [email protected]

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Panat Yanpiset MD,

Panat Yanpiset MD

Department of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA

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Chalothorn Wannaphut MD,

Chalothorn Wannaphut MD

Department of Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, USA

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Thanathip Suenghataiphorn MD,

Thanathip Suenghataiphorn MD

Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

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Pongprueth Rujirachun MD,

Pongprueth Rujirachun MD

Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

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Pojsakorn Danpanichkul MD,

Pojsakorn Danpanichkul MD

Department of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA

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Natchaya Polpichai MD,

Natchaya Polpichai MD

Department of Medicine, Weiss Memorial Hospital, Chicago, Illinois, USA

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Sakditad Saowapa MD,

Sakditad Saowapa MD

Department of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA

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Jakrin Kewcharoen MD,

Jakrin Kewcharoen MD

orcid.org/0000-0003-0959-5576

Division of Cardiology, University of California San Francisco, San Francisco, California, USA

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Nipith Charoenngam MD,

Nipith Charoenngam MD

Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA

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Patompong Ungprasert MD,

Patompong Ungprasert MD

Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio, USA

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Phuuwadith Wattanachayakul MD,

Corresponding Author

Phuuwadith Wattanachayakul MD

[email protected]

orcid.org/0000-0003-0086-5269

Department of Medicine, Jefferson Einstein Hospital, Philadelphia, Pennsylvania, USA

Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA

Correspondence

Phuuwadith Wattanachayakul, MD, Department of Medicine, Jefferson Einstein Hospital, Philadelphia, PA 19141, USA.

Email: [email protected]

Search for more papers by this author

Panat Yanpiset MD,

Panat Yanpiset MD

Department of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA

Search for more papers by this author

Chalothorn Wannaphut MD,

Chalothorn Wannaphut MD

Department of Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, USA

Search for more papers by this author

Thanathip Suenghataiphorn MD,

Thanathip Suenghataiphorn MD

Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

Search for more papers by this author

Pongprueth Rujirachun MD,

Pongprueth Rujirachun MD

Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

Search for more papers by this author

Pojsakorn Danpanichkul MD,

Pojsakorn Danpanichkul MD

Department of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA

Search for more papers by this author

Natchaya Polpichai MD,

Natchaya Polpichai MD

Department of Medicine, Weiss Memorial Hospital, Chicago, Illinois, USA

Search for more papers by this author

Sakditad Saowapa MD,

Sakditad Saowapa MD

Department of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA

Search for more papers by this author

Jakrin Kewcharoen MD,

Jakrin Kewcharoen MD

orcid.org/0000-0003-0959-5576

Division of Cardiology, University of California San Francisco, San Francisco, California, USA

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Nipith Charoenngam MD,

Nipith Charoenngam MD

Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA

Search for more papers by this author

Patompong Ungprasert MD,

Patompong Ungprasert MD

Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio, USA

Search for more papers by this author

First published: 09 September 2024

https://doi.org/10.1111/pace.15069

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Abstract

Background

Recent studies have demonstrated an obesity paradox, where obese patients with cardiovascular disease have a better outcome compared to those with normal weight. However, the effect of obesity and body mass index (BMI) on the outcome of patients with cardiac resynchronization therapy (CRT) devices remains unclear. The current study aims to investigate this relationship using all available published data.

Methods

We systematically reviewed studies from Medline and EMBASE databases from inception to January 2024. Eligible studies must investigate the association between BMI status and all-cause mortality in individuals with CRT devices. Relative risk (RR) or hazard ratio (HR) and 95% CIs were retrieved from each study and combined using the generic inverse variance method.

Results

A total of 12 cohort studies were included in the meta-analysis. Pooled analysis showed that overweight and obesity patients had lower all-cause mortality compared to those with normal body weight with the pooled risk ratios (RR) for overweight of 0.77 (95% CI 0.69–0.87, I² 47%) and for obesity of 0.81 (95% CI 0.67–0.97, I² 59%). Conversely, the underweight exhibited higher all-cause mortality than the group with normal weight, with a pooled RR of 1.37 (95% CI 1.14–1.64, I² 0%). Additionally, higher BMI as continuous data was associated with decreased all-cause mortality, with a pooled HR of 0.94 (95% CI 0.89–0.98, I² 72%).

Conclusions

The pooled analyses observed an obesity paradox in patients with CRT, where overweight and obesity were associated with reduced all-cause mortality, while underweight individuals exhibited higher all-cause mortality. Further research is necessary to investigate the underlying mechanisms and their implications for clinical practice.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflicts of interest.

Open Research

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Supporting Information

REFERENCES

1Branca F, Ursu P, Aguayo V. A plan for accelerated action on obesity. Lancet Glob Health. 2023; 11: e1170-e1171. doi:10.1016/S2214-109X(23)00257-7
10.1016/S2214-109X(23)00257-7
CAS PubMed Google Scholar
2 NCD Risk Factor Collaboration (NCD-RisC). Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19·2 million participants. Lancet. 2016; 387: 1377-1396. doi:10.1016/S0140-6736(16)30054-X
10.1016/S0140-6736(16)30054-X
PubMed Web of Science® Google Scholar
3Ward Zachary J, Bleich Sara N, Cradock Angie L, et al. Projected U.S. state-level prevalence of adult obesity and severe obesity. N Engl J Med. 2019; 381: 2440-2450. doi:10.1056/NEJMsa1909301
10.1056/NEJMsa1909301
CAS PubMed Google Scholar
4Hruby A, Hu FB. The epidemiology of obesity: a big picture. Pharmacoeconomics. 2015; 33: 673-689. doi:10.1007/s40273-014-0243-x
10.1007/s40273-014-0243-x
PubMed Web of Science® Google Scholar
5Lim JU, Lee JH, Kim JS, et al. Comparison of World Health Organization and Asia-Pacific body mass index classifications in COPD patients. Int J Chron Obstruct Pulmon Dis. 2017; 12: 2465-2475. doi:10.2147/COPD.S141295
10.2147/COPD.S141295
CAS PubMed Web of Science® Google Scholar
6Powell-Wiley TM, Poirier P, Burke LE, et al. Obesity and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2021; 143: e984-1010. doi:10.1161/CIR.0000000000000973
10.1161/CIR.0000000000000973
PubMed Web of Science® Google Scholar
7Nutter S, Eggerichs LA, Nagpal TS, et al. Changing the global obesity narrative to recognize and reduce weight stigma: a position statement from the World Obesity Federation. Obes Rev. 2024; 25:e13642. doi:10.1111/obr.13642
10.1111/obr.13642
PubMed Web of Science® Google Scholar
8Simati S, Kokkinos A, Dalamaga M, Argyrakopoulou G. Obesity paradox: fact or fiction? Curr Obes Rep. 2023; 12: 75-85. doi:10.1007/s13679-023-00497-1
10.1007/s13679-023-00497-1
PubMed Google Scholar
9Neeland IJ, Das SR, Simon DN, et al. The obesity paradox, extreme obesity, and long-term outcomes in older adults with ST-segment elevation myocardial infarction: results from the NCDR. Eur Heart J Qual Care Clin Outcomes. 2017; 3: 183-191. doi:10.1093/ehjqcco/qcx010
10.1093/ehjqcco/qcx010
PubMed Web of Science® Google Scholar
10Horwich TB, Fonarow GC, Clark AL. Obesity and the obesity paradox in heart failure. Prog Cardiovasc Dis. 2018; 61: 151-156. doi:10.1016/j.pcad.2018.05.005
10.1016/j.pcad.2018.05.005
PubMed Web of Science® Google Scholar
11Carbone S, Lavie CJ, Arena R. Obesity and heart failure: focus on the obesity paradox. Mayo Clin Proc. 2017; 92: 266-279. doi:10.1016/j.mayocp.2016.11.001
10.1016/j.mayocp.2016.11.001
PubMed Web of Science® Google Scholar
12Higgins SL, Hummel JD, Niazi IK, et al. Cardiac resynchronization therapy for the treatment of heart failure in patients with intraventricular conduction delay and malignant ventricular tachyarrhythmias. J Am Coll Cardiol. 2003; 42: 1454-1459. doi:10.1016/s0735-1097(03)01042-8
10.1016/S0735-1097(03)01042-8
PubMed Web of Science® Google Scholar
13Ziaeian B, Zhang Y, Albert NM, et al. Clinical effectiveness of CRT and ICD therapy in heart failure patients by racial/ethnic classification. J Am Coll Cardiol. 2014; 64: 797-807. doi:10.1016/j.jacc.2014.05.060
10.1016/j.jacc.2014.05.060
PubMed Web of Science® Google Scholar
14Aktas MK, Zareba W, Huang DT, et al. The effect of weight loss on clinical outcomes in patients implanted with a cardiac resynchronization therapy device-A MADIT-CRT substudy. J Card Fail. 2014; 20: 183-189. doi:10.1016/j.cardfail.2013.12.012
10.1016/j.cardfail.2013.12.012
PubMed Web of Science® Google Scholar
15Cai C, Hua W, Ding L-G, et al. Association of body mass index with cardiac reverse remodeling and long-term outcome in advanced heart failure patients with cardiac resynchronization therapy. Circ J. 2014; 78: 2899-2907. doi:10.1253/circj.cj-14-0812
10.1253/circj.CJ-14-0812
PubMed Web of Science® Google Scholar
16Echouffo-Tcheugui JB, Masoudi FA, Bao H, Curtis JP, Heidenreich PA, Fonarow GC. Body mass index and outcomes of cardiac resynchronization with implantable cardioverter-defibrillator therapy in older patients with heart failure. Eur J Heart Fail. 2019; 21: 1093-1102. doi:10.1002/ejhf.1552
10.1002/ejhf.1552
PubMed Web of Science® Google Scholar
17Galloo X, Khidir M, Stassen J, et al. Risk factors for short-term versus long-term mortality in patients who underwent cardiac resynchronization therapy. Am J Cardiol. 2023; 197: 34-41. doi:10.1016/j.amjcard.2023.03.026
10.1016/j.amjcard.2023.03.026
PubMed Google Scholar
18Grandin EW, Wand A, Zamani P, Rame JE, Verdino RJ. Relation of body mass index to long-term survival after cardiac resynchronization therapy. Am J Cardiol. 2016; 118: 1861-1867. doi:10.1016/j.amjcard.2016.08.079
10.1016/j.amjcard.2016.08.079
PubMed Web of Science® Google Scholar
19Il'Giovine ZJ, Patel D, Kumar A, et al. Obesity predicts survival after cardiac resynchronization therapy independent of effect on left ventricular ejection fraction. Circ Heart Fail. 2020; 13:e007424. doi:10.1161/CIRCHEARTFAILURE.120.007424
10.1161/CIRCHEARTFAILURE.120.007424
PubMed Web of Science® Google Scholar
20Krøll J, Kristensen SL, Jespersen CHB, et al. Long-term cardiovascular outcomes among immigrants and non-immigrants in cardiac resynchronization therapy: a nationwide study. Europace. 2023; 25:euad148. doi:10.1093/europace/euad148
10.1093/europace/euad148
PubMed Google Scholar
21Merkel ED, Behon A, Schwertner WR, et al. The risk of obesity and the association of body mass index on all-cause mortality after cardiac resynchronization therapy. Europace. 2023; 25:euad122. doi:10.1093/europace/euad122.453
10.1093/europace/euad122.453
Google Scholar
22Papageorgiou N, Briasoulis A, Barra S, et al. Long-term impact of body mass index on survival of patients undergoing cardiac resynchronization therapy: a multi-centre study. Am J Cardiol. 2021; 153: 79-85. doi:10.1016/j.amjcard.2021.05.024
10.1016/j.amjcard.2021.05.024
PubMed Web of Science® Google Scholar
23Passos LCS, Viana TT, Carvalho W, et al. Judgement of the multidisciplinary team is an important predictor of mortality after cardiac resynchronization therapy. ESC Heart Fail. 2021; 8: 5275-5281. doi:10.1002/ehf2.13611
10.1002/ehf2.13611
PubMed Web of Science® Google Scholar
24Winkler A, Jaguś-Jamioła A, Uziębło-Życzkowska B. Predictors of appropriate interventions and mortality in patients with implantable cardioverter-defibrillators. Pol Arch Intern Med. 2019; 129: 667-672. doi:10.20452/pamw.14967
10.20452/pamw.14967
PubMed Google Scholar
25Yanagisawa S, Inden Y, Shimano M, et al. Impact of cardiac resynchronization therapy-defibrillator implantation on the association between body mass index and prognosis in patients with heart failure. J Interv Card Electrophysiol. 2015; 43: 269-277. doi:10.1007/s10840-015-0015-3
10.1007/s10840-015-0015-3
PubMed Web of Science® Google Scholar
26Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010; 25: 603-605. doi:10.1007/s10654-010-9491-z
10.1007/s10654-010-9491-z
PubMed Web of Science® Google Scholar
27DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986; 7: 177-188. doi:10.1016/0197-2456(86)90046-2
10.1016/0197-2456(86)90046-2
CAS PubMed Google Scholar
28Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003; 327: 557-560.
10.1002/sim.1186
PubMed Google Scholar
29Nowak B, Sinha AM, Schaefer WM, et al. Cardiac resynchronization therapy homogenizes myocardial glucose metabolism and perfusion in dilated cardiomyopathy and left bundle branch block. J Am Coll Cardiol. 2003; 41: 1523-1528. doi:10.1016/s0735-1097(03)00257-2
10.1016/S0735-1097(03)00257-2
PubMed Web of Science® Google Scholar
30Peterson LR, Soto PF, Herrero P, et al. Impact of gender on the myocardial metabolic response to obesity. JACC Cardiovasc Imaging. 2008; 1: 424-433. doi:10.1016/j.jcmg.2008.05.004
10.1016/j.jcmg.2008.05.004
PubMed Web of Science® Google Scholar
31Sundell J, Engblom E, Koistinen J, et al. The effects of cardiac resynchronization therapy on left ventricular function, myocardial energetics, and metabolic reserve in patients with dilated cardiomyopathy and heart failure. J Am Coll Cardiol. 2004; 43: 1027-1033. doi:10.1016/j.jacc.2003.10.044
10.1016/j.jacc.2003.10.044
PubMed Web of Science® Google Scholar
32Ukkonen H, Beanlands RSB, Burwash IG, et al. Effect of cardiac resynchronization on myocardial efficiency and regional oxidative metabolism. Circulation. 2003; 107: 28-31. doi:10.1161/01.cir.0000047068.02226.95
10.1161/01.CIR.0000047068.02226.95
CAS PubMed Web of Science® Google Scholar
33Nagarajan V, Kohan L, Holland E, Keeley EC, Mazimba S. Obesity paradox in heart failure: a heavy matter. ESC Heart Fail. 2016; 3: 227-234. doi:10.1002/ehf2.12120
10.1002/ehf2.12120
CAS PubMed Web of Science® Google Scholar
34Kenchaiah S, Pocock SJ, Wang D, et al. Body mass index and prognosis in patients with chronic heart failure: insights from the Candesartan in heart failure: assessment of reduction in mortality and morbidity (CHARM) program. Circulation. 2007; 116: 627-636. doi:10.1161/CIRCULATIONAHA.106.679779
10.1161/CIRCULATIONAHA.106.679779
PubMed Web of Science® Google Scholar
35Sharma A, Lavie CJ, Borer JS, et al. Meta-analysis of the relation of body mass index to all-cause and cardiovascular mortality and hospitalization in patients with chronic heart failure. Am J Cardiol. 2015; 115: 1428-1434. doi:10.1016/j.amjcard.2015.02.024
10.1016/j.amjcard.2015.02.024
PubMed Web of Science® Google Scholar
36Antonopoulos AS, Tousoulis D. The molecular mechanisms of obesity paradox. Cardiovasc Res. 2017; 113: 1074-1086. doi:10.1093/cvr/cvx106
10.1093/cvr/cvx106
CAS PubMed Web of Science® Google Scholar
37Antoniades C, Antonopoulos AS, Tousoulis D, Stefanadis C. Adiponectin: from obesity to cardiovascular disease. Obes Rev. 2009; 10: 269-279. doi:10.1111/j.1467-789X.2009.00571.x
10.1111/j.1467-789X.2009.00571.x
CAS PubMed Web of Science® Google Scholar

Volume47, Issue11

November 2024

Pages 1464-1473

Association between obesity paradox in the all-cause mortality among patients with cardiac resynchronization therapy device

Abstract

Background

Methods

Results

Conclusions

CONFLICT OF INTEREST STATEMENT

Open Research

DATA AVAILABILITY STATEMENT

Supporting Information

REFERENCES

References

Information

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Association between obesity paradox in the all-cause mortality among patients with cardiac resynchronization therapy device

Abstract

Background

Methods

Results

Conclusions

CONFLICT OF INTEREST STATEMENT

Open Research

DATA AVAILABILITY STATEMENT

Supporting Information

REFERENCES

References

Related

Information