Veselka J, Spaček M, Homolová I, Zimolová P. International Journal of Cardiology. 2014 Apr 1;172(3):600–1. doi: 10.1016/j.ijcard.2014.01.092. Epub 2014 Jan 24. IF: 5.509
Abstract
There is a growing body of evidence that obese or overweight patients with symptomatic atherosclerosis, heart failure, chronic kidney disease or after cardiac arrest have a better prognosis compared with normal weight counterparts. This phenomenon has been called the “obesity paradox” and was also described in patients with peripheral atherosclerotic disease. Carotid artery stenting (CAS) is an alternative therapeutic approach to patients with significant carotid stenoses. In this retrospective, single-center study we sought to determine whether the obesity paradox also exists in patients who undergo CAS.
In a total of 413 consecutive patients (69±9 years, 33% symptomatic, body mass index (BMI) 28.4±4.1, 36% females), we treated 505 significantly stenosed carotid arteries using the implantation of 512 stents. The median follow-up period was 4.1 years (1–8.3 years; 1,631 patient-years), there had been 103 deaths (25% of total population) at the conclusion of the study period, including the aforementioned early post-CAS deaths. The estimated 5-year freedom from all-cause death for all patients with baseline BMI ≤25 and BMI >25 was 66% (95% CI, 52–77%) and 77% (95% CI, 71–82%) (p=0.18), respectively. Similarly, there was no significant difference in the estimated 5-year survival of male patients with regard to baseline BMI (68%; 95% CI, 51–80% versus 76%; 95% CI, 69–82%; p=0.90). However, in female patients there was a significant difference in survival of patients with baseline BMI ≤25 and >25; survival free of all-cause mortality at 5 years was 64% (95% CI, 39–80%) versus 80% (95% CI, 70–87%) (p=0.035).
To our knowledge, this is the first study dealing with the long-term outcome of post-CAS patients considering BMI. According to our expectations, we demonstrated that a higher BMI was associated with a higher occurrence of diabetes, hypertension and severe bronchopulmonary disease. On the other hand, despite several inherent limitations of this retrospective and single-centre study, the results suggest that better long-term survival in patients with baseline BMI >25 might extend also to female patients after CAS.
http://www.internationaljournalofcardiology.com/article/S0167-5273%2814%2900303-9/abstract
