Dipesh Ludhwani
Medicine residency at Chicago Medical School, Northwestern Mchenry hospital
Title: THE PARADOX OF BODY MASS INDEX IN PERIPHERAL ARTERIAL DISEASE: RESULTS OF PROPENSITY MATCH ANALYSIS
Biography
Biography: Dipesh Ludhwani
Abstract
Introduction: The role of obesity in cardiovascular mortality is controversial. Obesity paradox has been widely attributed to smoking in underweight. Large scale studies analyzing outcomes of peripheral arterial disease (PAD) and obesity while accounting for confounders such as smoking are lacking.
Method: We identified admissions with a primary discharge diagnosis of PAD in the United States National Inpatient Sample (NIS) of 2016 using the ICD-10 CM diagnosis code. These admissions were further grouped based on the presence or absence of obesity as a secondary diagnosis. Obesity was defined as Body Mass Index (BMI) ≥ 25. Propensity scores were calculated to match both groups and control for age, smoking, diabetes amongst other confounders. Multivariate logistic and linear regression analysis was performed to calculate the odds ratio for amputation, need for intervention (angioplasty or bypass), in-hospital mortality and length of stay. PAD admissions without obesity were selected as the reference population. Results: Among 248,288 PAD-related admissions, 41,618 had a secondary diagnosis of obesity. After calculating propensity scores for 1-1 matching 41,589 admissions in PAD and obesity group were compared with a similar amount of admissions in the reference population. Patients with concomitant diagnosis of obesity were associated with lower odds of amputation (OR=0.90, 95% CI=0.84-0.95, p<0.001), need for intervention (OR=0.66, 95% CI=0.62-0.69, p<0.0001), in-hospital mortality (OR=0.81, 95% CI=0.74-0.87, p<0.0001) and length of stay (B=0.5, SE B=0.04, p<0.0001). The odds of having acute kidney injury were higher in the obese group (OR=1.30, 95% CI=1.26-1.34, p<0.0001) compared to the reference population.
Conclusion: The odds of amputation, invasive PAD intervention and in-hospital mortality were lower in obese patients. Despite increasing the risk of hypertension, diabetes, and overall prevalence of PAD, obesity paradox continues to exist with better short-term prognosis in these patients. Future studies looking into the pathophysiology behind this phenomenon are needed.