Stroke: In patients with atrial fibrillation, a higher BMI may reduce the risk of cerebrovascular events

Atrial fibrillation (AF) is the most common arrhythmic disorder, and the incidence of atrial fibrillation has increased worldwide.
atrial fibrillation was significantly associated with an increased risk of stroke, heart failure and death.
body mass index (BMI) has been shown to be closely related to atrial fibrillation events, as have other cardiovascular diseases.
and obesity are risk factors for atrial fibrillation, while underweight is also a risk factor for new atrial fibrillation.
BMI can also affect the risk of adverse outcomes in patients with atrial fibrillation.
Although higher BMI is associated with an increased risk of all-cause death in the general population, studies have shown that higher BMI can also be associated with beneficial clinical outcomes in patients with cardiovascular diseases such as hypertension, coronary heart disease, and heart failure.
, the impact of BMI on clinical outcomes in patients with atrial fibrillation remains controversial.
without considering the effects of oral anticoagulant (OAC) therapy, clinical outcomes, including stroke and haemorrhage, cannot be clarified, as OAC therapy is essential to prevent stroke in patients with atrial fibrillation.
previous studies on the effects of BMI on clinical outcomes in patients with atrial fibrillation treated with OAC have concluded that being overweight may be associated with beneficial clinical outcomes, including stroke and death, rather than haemorrhage.
, however, data are limited on the effects of underweight on clinical outcomes in patients with atrial fibrillation, especially since most of the subjects in these studies were non-Asians.
distribution of BMI in Asian populations is different from that of non-Asians, the main difference being that underweight patients are more common in Asians.
, there is little data to assess the relationship between BMI and outcome in asian atrial fibrillation patients.
, So-Ryoung Lee of Seoul University in South Korea and others used population-based queues nationwide to assess the relationship between BMI and clinical outcomes in Asian atrial fibrillation patients who reuseD OAC.
data from the Korean National Health Insurance Database between January 2015 and December 2017 screened new users of oral anticoagulants in patients with non-valve atrial fibrillation with BMI information.
ischemic stroke, intracranial haemorrhage, gastrointestinal bleeding hospitalization, haemorrhage, all-cause death and comprehensive clinical results were analyzed according to BMI grouping.
the study, a total of 43,173 patients were included in different BMI categories (kg/m2): underweight (-lt;18.5) was 3%, normal (18.5 to 23) 28%, overweight (23 to slt;25) 24%, obesity I (25 to slt;30) 39%, obesity II (≥30) 6%.
BMI (5kg/m2 per increase) is associated with a lower risk of ischemic stroke (HR 0.891), hospitalization for gastrointestinal bleeding (HR 0.785), and haemorrhage (HR) HR 0.794), all-cause death (HR 0.658) and comprehensive clinical outcomes (HR 0.751) were not related to intracranial haemorrhage (HR 0.815).
the underweight group was associated with an increased risk of integrated clinical outcomes (HR 1.398), mainly driven by an increased risk of death.
addition, the effects of non-vitamin K antagonists oral anticoagulants and huafarin on clinical outcomes were similar in each BMI group.
importance of this study is that higher BMI was found to be independently associated with lower ischemic stroke, hemorrhage risk and better survival rates in AF.
underweight patients are at higher risk of death and integrated clinical outcomes.
BMI for patients with atrial fibrillation should be determined and managed according to the integrated care path.
original origin: Lee, S. R., Choi, E. K., Jung, J. H., Park, S. H., Han, K. D., Oh, S., samp; Lip, G. Y. (2020). Body Mass Index and Clinical Outcomes in Asian Patients With Atrial Fibrillation Receiving Oral Anticoagulation. _Stroke_, STROKEAHA-120. Freeman Source: MedSci Original Copyright Notice: All text, images and audio and video materials on this website that indicate "Source: Mets Medicine" or "Source: MedSci Originals" are owned by Mets Medicine and are not reproduced by any media, website or individual without authorization, and must be reproduced with the words "Source: Mets Medicine".
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