Abstract 16314: The Obesity Paradox in Critical Limb Ischemia Patients (From J BEAT Registry)
Background: Previous reports indicate that the body mass index (BMI) is inversely related with mortality in peripheral arterial disease. However, such a relationship is unclear in critical limb ischemia (CLI) patients with isolated infrapopliteal disease.
METHODS: Between April 2004 and March 2012, 1093 CLI consecutive patients (760 men; mean age 72±10 years) who underwent balloon angioplasty for primary treatment of isolated infrapopliteal artery lesions in 1314 limbs were enrolled in a multicenter, non-randomized registry. Patients were classified as underweight group (less than 18.5 kg/m2, 191 patients with 222 limbs), normal group (18.5 to 24.9 kg/m2,720 patients with 874 limbs), overweight group (over 25.0 kg/m2,179 patients with 214 limbs), and unknown (2 patients with 4 limbs). We examined clinical outcomes [major advance limb event (MALE; major amputation or any reintervention), amputation free survival (AFS), and survival)] of them at an average 664 ± 590 days retrospectively. We also evaluated the relationship between BMI and other factors.
RESULTS: Freedom from MALE at 3 years showed no significant difference in each group (33.8%, 41.2%, 43.1% respectively, P = 0.31). However, AFS and survival at 3 years showed significant difference in each group (AFS; 38.7 %, 57.2%, 64.1%, respectively, P < .0001. survival; 46.4%, 66.1%, 73.4%, respectively, P < .0001). The adjusted hazard ratio for mortality of underweight group vs normal group was 1.67 (95% CI, 1.371-2.258; P < .0001), vs overweight group was 2.48 (95% CI, 1.73-3.614; P < .0001). BMI had positive correlations with cholesterol and albumin level and negative correlations with hemodialysis and chronic obstructive pulmonary disease (P < 0.05).
Conclusions: Low BMI is significant risk factors for mortality in CLI patients with isolated infrapopliteal disease. This obesity paradox could be explained by malnutrition and systemic inflammation due to hemodialysis or chronic obstructive pulmonary disease.
- © 2013 by American Heart Association, Inc.