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OBESITY PARADOX FOR STROKE IN PATIENTS WITH ATRIAL FIBRILLATION TREATED WITH RIVAROXABAN AND WARFARIN IN THE ROCKET AF TRIAL
A371 JACC April 1, 2014 Volume 63, Issue 12
Arrhythmias and Clinical EP Obesity Paradox for Stroke in Patients with Atrial Fibrillation Treated with Rivaroxaban and Warfarin in the ROCKET AF Trial Poster Contributions Hall C Sunday, March 30, 2014, 9:45 a.m.-10:30 a.m.
Session Title: Arrhythmias and Clinical EP: Basic Abstract Category: 5. Arrhythmias and Clinical EP: Basic Presentation Number: 1180-92 Authors: Somasekhara R. Balla, Derek Cyr, Yuliya Lokhnygina, Richard Becker, Scott Berkowitz, Guenter Breithardt, Robert Califf, Keith Fox, Werner Hacke, Jonathan Halperin, Graeme Hankey, Kenneth Mahaffey, Christopher Nessel, Jonathan Piccini, Daniel Singer, Manesh Patel, Halifax Medical Specialists, Roanoke Rapids, NC, USA, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA Background: Obesity is a risk factor for development of atrial fibrillation (AF). The impact on stroke outcomes in patients with AF is unknown. We investigated stroke outcomes in normal weight ([NW] BMI 18.50-24.99 kg/m2), overweight ([OW] BMI 25.00-29.99kg/m2), and obese ([OB] BMI ≥30 kg/m2) patients with AF treated with rivaroxaban and warfarin. Methods: We compared the incidence of stroke and systemic embolic events (SEE) in NW, OW, and OB patients in a post-hoc analysis of the ROCKET AF trial. Results: Over 2 years, stroke and SEE rates per 100 patient- years were 3.05 in NW (n=3289), 2.34 in OW (n=5535; HR 0.77, 95% CI 0.62-0.95, P=0.013), and 1.90 in OB patients (n=5206; HR 0.62, 95% CI 0.50-0.78, P<0.001). Stroke outcomes for all patients are shown (Figure); similar results were observed in rivaroxaban and warfarin groups. OB and OW patients exhibited significantly less risk of stroke than NW patients even after adjustment for hypertension, diabetes, CHF, prior stroke/TIA, age, sex, and serum creatinine (OW: HR 0.79, 95% CI 0.64-0.98, P=0.029; OB: HR 0.66, 95% CI 0.53-0.84, P=<0.001). Conclusion: Obesity may represent an independent predictor of favorable outcome for stroke in patients with AF who are anticoagulated.
Arrhythmias and Clinical EP Obesity Paradox for Stroke in Patients with Atrial Fibrillation Treated with Rivaroxaban and Warfarin in the ROCKET AF Trial Poster Contributions Hall C Sunday, March 30, 2014, 9:45 a.m.-10:30 a.m.
Session Title: Arrhythmias and Clinical EP: Basic Abstract Category: 5. Arrhythmias and Clinical EP: Basic Presentation Number: 1180-92 Authors: Somasekhara R. Balla, Derek Cyr, Yuliya Lokhnygina, Richard Becker, Scott Berkowitz, Guenter Breithardt, Robert Califf, Keith Fox, Werner Hacke, Jonathan Halperin, Graeme Hankey, Kenneth Mahaffey, Christopher Nessel, Jonathan Piccini, Daniel Singer, Manesh Patel, Halifax Medical Specialists, Roanoke Rapids, NC, USA, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA Background: Obesity is a risk factor for development of atrial fibrillation (AF). The impact on stroke outcomes in patients with AF is unknown. We investigated stroke outcomes in normal weight ([NW] BMI 18.50-24.99 kg/m2), overweight ([OW] BMI 25.00-29.99kg/m2), and obese ([OB] BMI ≥30 kg/m2) patients with AF treated with rivaroxaban and warfarin. Methods: We compared the incidence of stroke and systemic embolic events (SEE) in NW, OW, and OB patients in a post-hoc analysis of the ROCKET AF trial. Results: Over 2 years, stroke and SEE rates per 100 patient- years were 3.05 in NW (n=3289), 2.34 in OW (n=5535; HR 0.77, 95% CI 0.62-0.95, P=0.013), and 1.90 in OB patients (n=5206; HR 0.62, 95% CI 0.50-0.78, P<0.001). Stroke outcomes for all patients are shown (Figure); similar results were observed in rivaroxaban and warfarin groups. OB and OW patients exhibited significantly less risk of stroke than NW patients even after adjustment for hypertension, diabetes, CHF, prior stroke/TIA, age, sex, and serum creatinine (OW: HR 0.79, 95% CI 0.64-0.98, P=0.029; OB: HR 0.66, 95% CI 0.53-0.84, P=<0.001). Conclusion: Obesity may represent an independent predictor of favorable outcome for stroke in patients with AF who are anticoagulated.