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Obesity Associates with Increased Risk of Sudden Cardiac Death: A Systematic Review and Meta-Analysis
Abstracts
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326 Normal BMI is a Significant Independent Predictor of Spontaneously Occurring Ventricular Arrhythmias and Mortality in Patients with Myocardial Infarction, Left Ventricular Dysfunction and ICD Implantation R. Samanta 1,2,∗ , S. Kumar 2,3 , J. Pouliopoulos 2,3 , A. Narayan 3 , P. Qian 2,3 , S. Thomas 3 , P. Kovoor 2,3 , A. Thiagalingam 2,3 1 Flinders
Medical Centre, Adelaide, Australia of Sydney, Sydney, Australia 3 Westmead Hospital, Sydney, Australia 2 University
Background: There is little known about the influence of BMI on ventricular arrhythmias in patients with ischaemic heart disease. Aim: The aim of our study was to assess the effect of BMI on the combined primary outcome of spontaneously occurring ventricular arrhythmias and mortality and the individual secondary outcomes of mortality and spontaneous ventricular arrhythmias in patients with STEMI, LV-dysfunction and ICD implantation. Methods: 123 consecutive patients with LV ejection fraction ≤ 40% after STEMI and who underwent ICD insertion either for primary or secondary prevention were included. Patients were classified as normal (43.9%), overweight (35%) or obese (20.3%). Results: The primary outcome occurred in 36% of the patients with normal weight which was more than those who were overweight and obese (5.4% and 11.5% respectively, p0.001). Kaplan–Meier curves and the log-rank test revealed that overweight and obese patients had significantly lower incidence of death and ventricular arrhythmias (p < 0.01) in comparison to normal weight individuals. Using a Cox regression multivariable analysis when adjusting for ejection fraction, age and triple vessel disease, normal BMI remained a significant predictor for the primary outcome. Mortality was higher in normal weight patients (10%) compared to overweight (5.3%) and obese (3.8%) patients. Overweight and obese patients demonstrated a non-significant trend towards reduced survival in patients with normal weight (p = 0.346). Conclusion: In patients with post-MI LV dysfunction and ICD insertion, BMI remained a significant predictor for the combined primary outcome of spontaneously occurring ventricular arrhythmias and mortality. Our findings are consistent with the obesity paradox. http://dx.doi.org/10.1016/j.hlc.2017.06.327
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327 Obesity Associates with Increased Risk of Sudden Cardiac Death: A Systematic Review and Meta-Analysis T. Agbaedeng 1,∗ , R. Mahajan 1,2 , D. Munawar 1 , A. Elliott 1 , D. Twomey 1 , K. Khokhar 1 , D. Lau 1,2 , P. Sanders 1,2 1 Centre
for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia 2 Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, Adelaide, Australia Background: Sudden cardiac death (SCD) is a major public health issue and is identified as an important cause of cardiac mortality. Obesity is an emerging cardiovascular risk factor and has been associated with SCD. However, the strength of this association is not clearly defined, and is not evaluated for different measures of adiposity. Therefore, we aimed to evaluate this relation in a meta-analysis. Methods: PubMed, Embase/Cochrane Registers were searched using keywords: “sudden cardiac death”, “obesity” and “weight gain”, with 190 articles retrieved. After exclusions, 10 prospective cohort studies were pooled in a random effects meta-analysis and presented as risk ratio (RR). Primary outcome was a diagnosis of SCD, defined as sudden death within 1 hour of symptoms onset. Obese body mass index (BMI ≥30 Kg/m2 ) and high waist-to-hip ratio (WHR) were reported as weight measures Results: See Figure. 1,309,736 patients follow-up ≥8 years demonstrated that obesity results in a significant 31% increased risk for SCD even after adjusting for comorbidities (RR: 1.31; 95% CI: 1.04-1.65; p = 0.02). No significantly increased risk of SCD were seen in both underweight and overweight BMI group (RR: 1.35, 95% CI: 0.98-1.85, p = 0.06; and RR: 1.12, 95% CI: 0.91-1.38, p = 0.27). Furthermore, high WHR significantly predicted future risk of SCD, and this was independent of baseline covariates (RR: 1.30, 95% CI: 1.001.69, p < 0.01).
Fig..
Conclusions: Obesity, as measured by BMI and high WHR, was associated with elevated risk of SCD. Further research is required to understand the mechanism of this association. http://dx.doi.org/10.1016/j.hlc.2017.06.328
S186
326 Normal BMI is a Significant Independent Predictor of Spontaneously Occurring Ventricular Arrhythmias and Mortality in Patients with Myocardial Infarction, Left Ventricular Dysfunction and ICD Implantation R. Samanta 1,2,∗ , S. Kumar 2,3 , J. Pouliopoulos 2,3 , A. Narayan 3 , P. Qian 2,3 , S. Thomas 3 , P. Kovoor 2,3 , A. Thiagalingam 2,3 1 Flinders
Medical Centre, Adelaide, Australia of Sydney, Sydney, Australia 3 Westmead Hospital, Sydney, Australia 2 University
Background: There is little known about the influence of BMI on ventricular arrhythmias in patients with ischaemic heart disease. Aim: The aim of our study was to assess the effect of BMI on the combined primary outcome of spontaneously occurring ventricular arrhythmias and mortality and the individual secondary outcomes of mortality and spontaneous ventricular arrhythmias in patients with STEMI, LV-dysfunction and ICD implantation. Methods: 123 consecutive patients with LV ejection fraction ≤ 40% after STEMI and who underwent ICD insertion either for primary or secondary prevention were included. Patients were classified as normal (43.9%), overweight (35%) or obese (20.3%). Results: The primary outcome occurred in 36% of the patients with normal weight which was more than those who were overweight and obese (5.4% and 11.5% respectively, p0.001). Kaplan–Meier curves and the log-rank test revealed that overweight and obese patients had significantly lower incidence of death and ventricular arrhythmias (p < 0.01) in comparison to normal weight individuals. Using a Cox regression multivariable analysis when adjusting for ejection fraction, age and triple vessel disease, normal BMI remained a significant predictor for the primary outcome. Mortality was higher in normal weight patients (10%) compared to overweight (5.3%) and obese (3.8%) patients. Overweight and obese patients demonstrated a non-significant trend towards reduced survival in patients with normal weight (p = 0.346). Conclusion: In patients with post-MI LV dysfunction and ICD insertion, BMI remained a significant predictor for the combined primary outcome of spontaneously occurring ventricular arrhythmias and mortality. Our findings are consistent with the obesity paradox. http://dx.doi.org/10.1016/j.hlc.2017.06.327
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327 Obesity Associates with Increased Risk of Sudden Cardiac Death: A Systematic Review and Meta-Analysis T. Agbaedeng 1,∗ , R. Mahajan 1,2 , D. Munawar 1 , A. Elliott 1 , D. Twomey 1 , K. Khokhar 1 , D. Lau 1,2 , P. Sanders 1,2 1 Centre
for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia 2 Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, Adelaide, Australia Background: Sudden cardiac death (SCD) is a major public health issue and is identified as an important cause of cardiac mortality. Obesity is an emerging cardiovascular risk factor and has been associated with SCD. However, the strength of this association is not clearly defined, and is not evaluated for different measures of adiposity. Therefore, we aimed to evaluate this relation in a meta-analysis. Methods: PubMed, Embase/Cochrane Registers were searched using keywords: “sudden cardiac death”, “obesity” and “weight gain”, with 190 articles retrieved. After exclusions, 10 prospective cohort studies were pooled in a random effects meta-analysis and presented as risk ratio (RR). Primary outcome was a diagnosis of SCD, defined as sudden death within 1 hour of symptoms onset. Obese body mass index (BMI ≥30 Kg/m2 ) and high waist-to-hip ratio (WHR) were reported as weight measures Results: See Figure. 1,309,736 patients follow-up ≥8 years demonstrated that obesity results in a significant 31% increased risk for SCD even after adjusting for comorbidities (RR: 1.31; 95% CI: 1.04-1.65; p = 0.02). No significantly increased risk of SCD were seen in both underweight and overweight BMI group (RR: 1.35, 95% CI: 0.98-1.85, p = 0.06; and RR: 1.12, 95% CI: 0.91-1.38, p = 0.27). Furthermore, high WHR significantly predicted future risk of SCD, and this was independent of baseline covariates (RR: 1.30, 95% CI: 1.001.69, p < 0.01).
Fig..
Conclusions: Obesity, as measured by BMI and high WHR, was associated with elevated risk of SCD. Further research is required to understand the mechanism of this association. http://dx.doi.org/10.1016/j.hlc.2017.06.328