Body mass index is inversely associated with mortality in patients with peripheral vascular disease

•No current guidelines for managing weight in peripheral vascular disease (PVD).•Obese patients with PVD have improved survival.•Underweight predicts early mortality in PVD patients.

BackgroundCurrent guidelines contain no advice on how to manage obesity and underweight in patients with peripheral vascular disease (PVD).ObjectivesThe aim of this study was to assess the association of underweight, overweight and obesity with mortality in patients with PVD.Patients and MethodsWe recruited 1472 patients with a broad range of presentations of PVD. Underweight, overweight and obesity were defined by body mass index (BMI) and associated with mortality using Kaplan Meier and Cox proportional hazard analyses.ResultsSurvival at 3 years was 37.5, 78.1, 86.8 and 87.0% for patients that were underweight, normal weight, overweight and obese at recruitment, respectively, p < 0.001. Patients that were underweight had approximately twice the risk of dying (RR 2.15, 95% CI 1.31-3.55, p = 0.003), while patients that were overweight (RR 0.67, 95% CI 0.49-0.91, p = 0.011) or obese (RR 0.59, 95% CI 0.41-0.85, p = 0.005) had approximately half the risk of dying, after adjustment for other risk factors and using normal weight subjects as the reference group. 823 patients had waist circumference measured at recruitment. Patients with waist circumference in the top quartile had half the risk of dying (RR 0.50, 95% CI 0.26-0.98, p = 0.045). In 267 patients we assessed the relationship between BMI and abdominal fat volumes using computed tomography. BMI was highly correlated with both intra-abdominal and subcutaneous fat volumes.ConclusionsObesity whether assessed by BMI or central fat deposition is associated with reduced risk of dying in patients with established PVD. Underweight is highly predictive of early mortality in patients with PVD.