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Int J Obes (Lond). 2017 Aug 30. doi: 10.1038/ijo.2017.211. [Epub ahead of print]

Presence of obesity is associated with lower mortality in elderly patients with implantable cardioverter defibrillator.

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From the Center for Integrative Research on Cardiovascular Aging (CIRCA), Aurora Research Institute, Aurora University of Wisconsin Medical Group.
Aurora Cardiovascular Services, Aurora Sinai/Aurora St Luke's Medical Centers.
Aurora Health Care, Wisconsin, USA.



Higher body mass index (BMI) is associated with greater prevalence of cardiovascular risk factors, yet an inverse relationship between obesity and survival after cardiovascular events has been described. It is unclear whether a similar relationship exists for patients with implantable cardioverter defibrillators (ICD) at high risk for mortality. We aimed to assess the impact of BMI on mortality and cardiovascular hospitalization in patients with ICD.


Patients who underwent ICD implantation in 2010-2011 were divided into normal (<25 kg/m2), overweight (25-29.9 kg/m2), and obese (⩾30 kg/m2) groups based on BMI. Clinical parameters were compared and long-term outcomes determined using chi square, Wilcoxon rank sum test, logistic regression models, and Kaplan-Meier curves.


Of 904 patients (mean age 67±13 years), 26% had normal BMI, 32% were overweight, and 42% were obese. No significant baseline differences in ventricular ejection fraction, ICD for primary or secondary prevention, history of heart failure, syncope, or cardiac arrest existed. Despite a greater prevalence of diabetes, hypertension, and prior myocardial infarction, the obese and overweight groups had lower mortality (10.1 and 7.9%, respectively) than the normal group (22.9%, P<0.001). On multivariate logistic regression, BMI in the obese and overweight range [odds ratio (95% CI): 0.35 (0.21-0.58) and 0.25 (0.13-0.40), respectively] was protective against mortality, while history of diabetes [OR (95% CI) 2.01 (1.30-3.09)], myocardial infraction [OR: 1.76 (1.11-2.80)], heart failure [OR: 3.88 (1.56-9.66)], stroke [OR: 3.19 (1.63-6.23)], and history of cardiac arrest [OR: 2.65 (1.37-5.15)] were independent risk factors for higher mortality.


A paradoxical relationship between BMI and mortality risk is present in elderly patients with ICD at high risk of sudden death with a lower mortality in obese or overweight patients than in those with normal BMI.International Journal of Obesity accepted article preview online, 30 August 2017. doi:10.1038/ijo.2017.211.

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