Michael C. Hill , Noah Kim , William Galanter , Ben S. Gerber , Colin C. Hubbard , Dawood Darbar , Mark D. McCauley
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Patients were grouped by body mass index (BMI) and statin use at time of AF diagnosis. Outcomes included all-cause mortality and ED or inpatient encounters for AF or CHF.</p></div><div><h3>Results and Conclusions</h3><p>A total of 2503 subjects were included (median age 66 years, 43.4 % female, median BMI 29.8 kg/m<sup>2</sup>, 54.6 % on baseline statin therapy). Increasing BMI was associated with decreased mortality hazard but not associated with AF/CHF encounter risk. Adjusting for statin-BMI interaction, demographics, and cardiovascular comorbidities, overweight non-statin users experienced improved mortality (adjusted hazard ratio [aHR] 0.55, 95 % CI 0.35–0.84) compared to statin users (aHR 0.98, 95 % CI 0.69–1.40; interaction P-value = 0.013). Mortality hazard was consistently lower in obese non-statin users than in statin users, however interaction was insignificant. No significant BMI-statin interactions were observed in AF/CHF encounter risk. In summary, statin use was not differentially associated with improved mortality or hospitalization risk in overweight/obese groups. These findings do not support statins for secondary prevention of adverse outcomes based on overweight/obesity status alone.</p></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":null,"pages":null},"PeriodicalIF":2.5000,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352906724001167/pdfft?md5=1823ff5ce7c92fea12f1a9e42b4434d5&pid=1-s2.0-S2352906724001167-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Association between obesity and statin use on mortality and hospital encounters in atrial fibrillation\",\"authors\":\"Michael C. Hill , Noah Kim , William Galanter , Ben S. Gerber , Colin C. Hubbard , Dawood Darbar , Mark D. 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Outcomes included all-cause mortality and ED or inpatient encounters for AF or CHF.</p></div><div><h3>Results and Conclusions</h3><p>A total of 2503 subjects were included (median age 66 years, 43.4 % female, median BMI 29.8 kg/m<sup>2</sup>, 54.6 % on baseline statin therapy). Increasing BMI was associated with decreased mortality hazard but not associated with AF/CHF encounter risk. Adjusting for statin-BMI interaction, demographics, and cardiovascular comorbidities, overweight non-statin users experienced improved mortality (adjusted hazard ratio [aHR] 0.55, 95 % CI 0.35–0.84) compared to statin users (aHR 0.98, 95 % CI 0.69–1.40; interaction P-value = 0.013). Mortality hazard was consistently lower in obese non-statin users than in statin users, however interaction was insignificant. No significant BMI-statin interactions were observed in AF/CHF encounter risk. 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引用次数: 0
摘要
背景肥胖会增加心房颤动(房颤)的风险,至少部分原因是由于促炎作用,但与此同时,肥胖却与死亡率的改善有着矛盾的联系。虽然他汀类药物具有多重抗炎特性,但其与肥胖和心房颤动临床结局之间的相互作用尚不清楚。我们探讨了体重指数、他汀类药物的使用与全因死亡率和房颤/充血性心力衰竭(CHF)相关病例之间的关系,假设他汀类药物的暴露可能与超重/肥胖患者的预后改善有不同程度的关联。根据体重指数(BMI)和确诊房颤时他汀类药物的使用情况对患者进行分组。结果包括全因死亡率和因房颤或慢性心房颤动而就诊的急诊室或住院患者人数。结果和结论共纳入 2503 名受试者(中位年龄 66 岁,43.4% 为女性,中位体重指数 29.8 kg/m2,54.6% 接受过他汀类药物治疗)。体重指数的增加与死亡率的降低有关,但与房颤/慢性阻塞性肺病的发病风险无关。调整他汀与体重指数的交互作用、人口统计学和心血管合并症后,与他汀使用者相比,超重非他汀使用者的死亡率有所提高(调整后危险比 [aHR] 0.55,95 % CI 0.35-0.84)(aHR 0.98,95 % CI 0.69-1.40;交互作用 P 值 = 0.013)。肥胖的非他汀类药物使用者的死亡率一直低于他汀类药物使用者,但交互作用不显著。在房颤/慢性阻塞性肺病发病风险方面,未观察到明显的体重指数-他汀相互作用。总之,在超重/肥胖人群中,他汀类药物的使用与死亡率或住院风险的改善并无差异。这些发现并不支持仅根据超重/肥胖状况将他汀类药物用于不良后果的二级预防。
Association between obesity and statin use on mortality and hospital encounters in atrial fibrillation
Background
Obesity increases risk of atrial fibrillation (AF) at least in part due to pro-inflammatory effects, but has been paradoxically associated with improved mortality. Although statins have pleiotropic anti-inflammatory properties, their interaction with obesity and clinical outcomes in AF is unknown. We explored the relationship between BMI, statin use, and all-cause mortality and AF/congestive heart failure (CHF)-related encounters, hypothesizing that statin exposure may be differentially associated with improved outcomes in overweight/obesity.
Methods
This was a single center retrospective cohort study of adults with AF diagnosed between 2011–2018. Patients were grouped by body mass index (BMI) and statin use at time of AF diagnosis. Outcomes included all-cause mortality and ED or inpatient encounters for AF or CHF.
Results and Conclusions
A total of 2503 subjects were included (median age 66 years, 43.4 % female, median BMI 29.8 kg/m2, 54.6 % on baseline statin therapy). Increasing BMI was associated with decreased mortality hazard but not associated with AF/CHF encounter risk. Adjusting for statin-BMI interaction, demographics, and cardiovascular comorbidities, overweight non-statin users experienced improved mortality (adjusted hazard ratio [aHR] 0.55, 95 % CI 0.35–0.84) compared to statin users (aHR 0.98, 95 % CI 0.69–1.40; interaction P-value = 0.013). Mortality hazard was consistently lower in obese non-statin users than in statin users, however interaction was insignificant. No significant BMI-statin interactions were observed in AF/CHF encounter risk. In summary, statin use was not differentially associated with improved mortality or hospitalization risk in overweight/obese groups. These findings do not support statins for secondary prevention of adverse outcomes based on overweight/obesity status alone.
期刊介绍:
IJC Heart & Vasculature is an online-only, open-access journal dedicated to publishing original articles and reviews (also Editorials and Letters to the Editor) which report on structural and functional cardiovascular pathology, with an emphasis on imaging and disease pathophysiology. Articles must be authentic, educational, clinically relevant, and original in their content and scientific approach. IJC Heart & Vasculature requires the highest standards of scientific integrity in order to promote reliable, reproducible and verifiable research findings. All authors are advised to consult the Principles of Ethical Publishing in the International Journal of Cardiology before submitting a manuscript. Submission of a manuscript to this journal gives the publisher the right to publish that paper if it is accepted. Manuscripts may be edited to improve clarity and expression.