Abstract 5157: Disparate Effects of Left Ventricular Geometry and Obesity on Mortality in Women with Preserved Systolic Function-The “Obesity Paradox” in Women
Background: LV geometry predicts CV events. Although obesity is a risk factor for CV diseases, studies demonstrate a paradox regarding obesity and prognosis. To our knowledge no studies have determined the impact of LV geometry on mortality by obesity status in women with preserved EF.
Methods: We evaluated 26,216 female patients with preserved EF, including 10,465 obese (BMI ≥ 30; age: 58.4 ± 14.1 yr) as well as 15,661 non-obese women (BMI < 30; age: 63.2 ± 16.9 yr) to determine the impact of LV geometry on mortality during an average follow-up of 1.7±1.0 yr.
Results: Abnormal LV geometry occurred more commonly in obese than non-obese females (47% vs 39%, p<0.0001 for difference in the four patterns). In obese females, concentric remodeling was the most prevalent abnormal pattern (30%), with eccentric and concentric hypertrophy occurring in 7% and 10%, respectively, compared with non-obese patients (25%, 6%, and 8% respectively). Overall mortality was considerably lower in obese than non-obese (5.6% vs 8.7%, p<0.0001), but mortality increased with abnormal LV geometry (Figure⇓). In both groups, higher age, relative wall thickness, and LV mass index were independent predictors of mortality. Higher BMI was associated with lower mortality [HR: 0.93 (0.92 – 0.94), p<0.0001] in non-obese whereas in obese was associated with higher mortality [HR: 1.03 (1.02 – 1.04), p<0.0001].
Conclusion: Although an obesity paradox exists, in that obesity is associated with higher prevalence of structural abnormalities but lower mortality, LV geometric abnormalities are prevalent in obese and non-obese females with preserved systolic function and are associated with increased mortality in both groups.