Arrhythmias and Conduction DisturbancesImpact of Body Mass Index on the Prognosis of Japanese Patients With Non-Valvular Atrial Fibrillation

Obesity is a risk factor for atrial fibrillation (AF); however, obesity is associated with lower mortality in patients with established AF, a phenomenon known as the obesity paradox. Previous studies reported inconsistent results regarding effects of body weight on risk of cardiogenic embolism in patients with AF. To determine relation between body mass index (BMI) and prognosis among Japanese patients with nonvalvular AF (NVAF), a post hoc analysis was conducted using observational data in the J-RHYTHM Registry. Subjects were categorized as underweight (BMI <18.5), normal (18.5 to 24.9), overweight (25.0 to 29.9), or obese (≥30 kg/m2). End points included thromboembolism, major hemorrhaging, all-cause mortality, and cardiovascular mortality. Of the 7,406 patients with NVAF, 6,379 patients (70 ± 10 years old; BMI, 23.6 ± 3.9 kg/m2) having baseline BMI data constituted the study group. During the 2-year follow-up period, 111 patients had thromboembolism, 124 experienced major hemorrhage, and 159 died. Multivariate analysis with the Cox proportional hazards model showed that none of the BMI categories were independent predictors of thromboembolism. However, being underweight was an independent predictor of all-cause mortality (hazard ratio [HR] 2.45; 95% confidence interval [CI] 1.62 to 3.69; p <0.001) and cardiovascular mortality (HR 3.00, 95% CI 1.52 to 5.91, p = 0.001) when normal weight was used as the reference. Additionally, being overweight was a predictor of lower all-cause mortality (HR 0.60, 95% CI 0.37 to 0.95, p = 0.029). In conclusion, being underweight is associated with higher risks of all-cause and cardiovascular mortality compared with having a normal weight. Being overweight or obese is not associated with increased mortality among Japanese patients with NVAF.