Clinical outcomes of obese and nonobese patients with atrial fibrillation according to associated metabolic abnormalities: A report from the COOL-AF registry
Issued Date
2023-01-01
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ISSN
17530393
eISSN
17530407
Scopus ID
2-s2.0-85179742009
Journal Title
Journal of Diabetes
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SCOPUS
Bibliographic Citation
Journal of Diabetes (2023)
Suggested Citation
Krittayaphong R., Boonyapiphat T., Winijkul A., Lip G.Y.H. Clinical outcomes of obese and nonobese patients with atrial fibrillation according to associated metabolic abnormalities: A report from the COOL-AF registry. Journal of Diabetes (2023). doi:10.1111/1753-0407.13519 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/95550
Title
Clinical outcomes of obese and nonobese patients with atrial fibrillation according to associated metabolic abnormalities: A report from the COOL-AF registry
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Abstract
Background: The primary objective was to determine the influence of obesity and associated metabolic status on clinical outcomes of Asian patients with atrial fibrillation (AF). Methods: This study was based on a prospective multicenter of patients with nonvalvular AF. Patients were classified as obese and nonobese and being metabolic unhealthy was defined as having at least one of the three cardiovascular risk factors including dyslipidemia, hypertension, or diabetes mellitus. Outcomes were a primary composite outcome of all-cause death, ischemic stroke/systemic embolism (SSE), acute myocardial infarction (MI), and heart failure (HF), as well as the individual end points. Results: There were a total of 3141 enrolled patients (mean age 67.4 ± 11.1 years; 41.0% female), of whom 1566 (49.9%) were obese and 2564 (81.6%) were metabolic unhealthy. During a mean follow-up of 32.2 ± 8.3 months, the incidence rate of the composite outcome, all-cause death, SSE, MI, and HF were 7.21 (6.63–7.82), 3.86 (3.45–4.30), 1.48 (1.23–1.77), 0.47 (0.33–0.64), and 2.84 (2.48–3.23) per 100 person-years, respectively. Metabolic unhealthy nonobese subjects were at higher risk of the composite outcomes than metabolic unhealthy obese subjects with hazard ratio (HR) 1.39, 95% confidence interval (CI) 1.17–1.66, p <.001. Metabolic unhealthy obese subjects tend to have an increased risk of the composite outcomes compared to those metabolic healthy obese (HR 1.36, 95% CI 0.91–2.02, p =.133). Metabolic healthy obese subjects were not associated with increased risk. Conclusions: Metabolic unhealthy obese subjects were associated with an increased risk of adverse outcomes in AF patients, whereas metabolically healthy obesity was not associated with an increased risk.