PT  - JOURNAL ARTICLE
AU  - Roopinder K Sandhu
AU  - Justin A Ezekowitz
AU  - Ziad Hijazi
AU  - Johan Westerbergh
AU  - Julia Aulin
AU  - John H Alexander
AU  - Christopher B Granger
AU  - Sigrun Halvorsen
AU  - Michael S Hanna
AU  - Renato D Lopes
AU  - Agneta Siegbahn
AU  - Lars Wallentin
TI  - Obesity paradox on outcome in atrial fibrillation maintained even considering the prognostic influence of biomarkers: insights from the ARISTOTLE trial
AID  - 10.1136/openhrt-2018-000908
DP  - 2018 Nov 01
TA  - Open Heart
PG  - e000908
VI  - 5
IP  - 2
4099  - http://openheart.bmj.com/content/5/2/e000908.short
4100  - http://openheart.bmj.com/content/5/2/e000908.full
SO  - Open Heart2018 Nov 01; 5
AB  - Objective We investigated the association between obesity and biomarkers indicating cardiac or renal dysfunction or inflammation and their interaction with obesity and outcomes.Methods A total of 14 753 patients in the Apixaban for Reduction In STroke and Other ThromboemboLic Events in Atrial Fibrillation (ARISTOTLE) trial provided plasma samples at randomisation to apixaban or warfarin. Median follow-up was 1.9 years. Body Mass Index (BMI) was measured at baseline and categorised as normal, 18.5–25  kg/m2; overweight, >25 to <30 kg/m2; and obese, ≥30 kg/m2. We analysed the biomarkers high-sensitivity C reactive protein (hs-CRP), interleukin 6 (IL-6), growth differentiation factor-15 (GDF-15), troponin T and N-terminal B-type natriuretic peptide (NT-pro-BNP). Outcomes included stroke/systemic embolism (SE), myocardial infarction (MI), composite (stroke/SE, MI, or all-cause mortality), all-cause and cardiac mortality, and major bleeding.Results Compared with normal BMI, obese patients had significantly higher levels of hs-CRP and IL-6 and lower levels of GDF-15, troponin T and NT-pro-BNP. In multivariable analyses, higher compared with normal BMI was associated with a lower risk of all-cause mortality (overweight: HR 0.73 (95% CI 0.63 to 0.86); obese: 0.67 (0.56 to 0.80), p<0.0001), cardiac death (overweight: HR 0.74 (95% CI 0.60 to 0.93); obese: 0.71 (0.56 to 0.92), p=0.01) and composite endpoint (overweight: 0.80 (0.70 to 0.92); obese: 0.72 (0.62 to 0.84), p<0.0001).Conclusions Regardless of biomarkers indicating inflammation or cardiac or renal dysfunction, obesity was independently associated with an improved survival in anticoagulated patients with AF.Trial registration number NCT00412984.