Effect of body mass index on mortality for diabetic patients with aortic stenosis

TL;DR

This study finds that being underweight increases mortality risk while obesity reduces it for diabetic patients with aortic stenosis.

Contribution

The study provides new evidence on how BMI affects mortality in diabetic patients with aortic stenosis.

Findings

Underweight diabetic patients with AS had higher all-cause mortality compared to normal weight individuals.

Obese patients had lower all-cause and cardiovascular mortality than normal weight patients.

Underweight patients faced higher non-cardiovascular mortality risks.

Abstract

Background: Several studies suggest an “obesity paradox,” associating obesity with better cardiovascular outcomes in patients with type 2 diabetes mellitus (DM) or aortic stenosis (AS) compared to normal or underweight individuals. This study explores the impact of body mass index (BMI) on diabetic patients with AS.

Methods: Between 2014 and 2019, patients with DM who underwent echocardiography were analyzed. Outcomes included all-cause mortality, cardiovascular, and non-cardiovascular death. Patients were categorized as underweight, normal weight, or obese based on BMI (<18.5, 18.5 to 27, and >27 kg/m2, respectively).

Results: Among 74,835 DM patients, 734 had AS. Normal weight comprised 65.5% (n=481), underweight 4.1% (N=30), and 30.4% were obese. Over a 6-year follow-up, underweight patients had significantly higher all-cause mortality (HR 1.96, 95% CI 1.22 – 3.14, p = 0.005), while obese patients had significantly lower mortality (HR 0.79, 95% CI 0.68 - 0.91, p=0.001) compared to the normal group. Regarding etiologies, underweight patients had a higher risk of non-cardiovascular death (HR 2.47, 95% CI 1.44-4.25, p = 0.001), while obese patients had a lower risk of cardiovascular death (HR 0.66, 95% CI 0.50-0.86, p=0.003). Subgroup analysis showed a consistent trend without significant interaction.

Conclusions: BMI significantly impacts mortality in DM patients with AS. Being underweight is associated with worse non-cardiovascular death, while obesity is linked to improved cardiovascular death outcomes.

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