Association between Body Mass Index and Clinical Outcomes of Peripheral Artery Disease after Endovascular Therapy: Data from K-VIS ELLA Registry

Abstract

Background and objectives: Few studies have investigated the obesity paradox in clinical outcomes of peripheral artery disease (PAD). We investigated the association between body mass index (BMI) and clinical outcomes in PAD patients undergoing endovascular therapy (EVT).

Methods: Patients (n=2,914) from the retrospective Korean Vascular Intervention Society Endovascular Therapy in Lower Limb Artery Disease registry were categorized according to BMI: underweight (<18.5 kg/m², n=204), normal weight (18.5-25 kg/m², n=1,818), overweight (25-30 kg/m², n=766), or obese (≥30 kg/m², n=126). Groups were compared for major adverse cardiovascular events (MACE) and major adverse limb events (MALE).

Results: The underweight and obese groups were older and had more frequent critical limb ischemia and infrapopliteal artery disease than the normal or overweight groups (all p<0.001). Hypertension and diabetes were more frequent and current smoking was less frequent in the overweight and obese groups than the underweight or normal weight groups (all p <0.001). The underweight group showed the higher rates of MACE and MALE at 3 years (17.2%, 15.7%) compared with the normal weight (10.8%, 11.7%), overweight (8.4%, 10.7%), or obese groups (8.7%, 14.3%) (log-rank p<0.001, p=0.015). In contrast, the risk of MACE was lower in the overweight than the normal weight group (adjusted hazard ratio, 0.706; 95% CI, 0.537-0.928).

Conclusions: In PAD patients undergoing EVT, underweight was an independent predictor for MACE and MALE, whereas MACE risk was lower for overweight than normal weight patients.

Trial registration: ClinicalTrials.gov Identifier: NCT02748226.

Keywords: Body mass index; Endovascular procedure; Peripheral artery disease; Prognosis.

Conflict of interest statement

The authors have no financial conflicts of interest.

Copyright © 2021. The Korean Society of Cardiology.

Figures

Figure 1. Kaplan-Meier curves of major clinical outcomes according to body mass index categories. (A) MACEs; (B) all-cause death; (C) MALEs; (D) TLR.

MACE = major adverse cardiac events; MALE = major adverse limb events; TLR = target lesion revascularization.

Figure 2. Negative non-linear association between BMI and risk of MACE (A) or MALE (B). The dotted lines indicate 95% confidence interval.

BMI = body mass index; HR = hazard ratio; MACE = major adverse cardiac events; MALE = major adverse limb events.