Effect of weight loss on early left atrial myopathy in obese patients without known cardiovascular disease

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): BHF & NIHR BRC Introduction Obesity is strongly associated with increased risk of heart failure and ischaemic stroke independently of associated co-morbidities. Left atrial (LA) reservoir dysfunction, a marker of atrial distensibility and compliance, is an early pathophysiological change which precedes the onset of cardiovascular disease in patients with obesity. It is unclear whether a weight loss intervention may be sufficient to reverse LA reservoir dysfunction. Purpose To longitudinally assess whether a weight loss intervention normalizes LA reservoir function by cardiac magnetic resonance (CMR) feature-tracking in patients with obesity and only subclinical cardiovascular disease and compared this age and sex matched non-obese normal weight controls. Methods A total of 45 patients with severe obese (age = 45 ± 11 years, body mass index = 39.1 ± 6.7 kg/m2, 51 ± 18 kg of excess body weight [EBW], 67% female) underwent CMR for quantification of LA and left ventricular (LV) size and function before and a median of 373 days following weight loss intervention. Weight loss was achieved by means of a very-low calorie diet (N = 28; 800 kcal/day) or by bariatric surgery (N = 17). A total of N = 27 non-obese healthy controls (age = 41 ± 12 years, body mass index = 22.3 ± 2.4 kg/m2, 75% female) underwent the same CMR protocol once. Results At baseline, patients with obesity displayed signs of atrial myopathy with increased LA volume and reduced LA reservoir function as compared to normal-weight controls (both P < 0.05, Figure 1) alongside increased LV mass and hyper-normal LV ejection fraction [LVEF] (both p < 0.01). As expected, weight loss led to a significant reduction of LA volume and LV mass with normalization of LVEF regardless of the degree of weight loss achieved (all P < 0.05, Figure 2). By contrast, only a large weight loss (>46.6% EBW, in red in Figure 2) was sufficient to improve and normalize the LA reservoir function (P < 0.05, Figure 2). On the other hand, moderate or milder weight loss (in orange and red) had no significant effect on LA reservoir function (both P > 0.05). Conclusion Successful weight loss can completely revert early LA myopathic phenotype in obese patients without known cardiovascular disease although this can be achieved only with larger weight loss targets.

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The Relationship between Body Mass Index and Mammographic Density during a Premenopausal Weight Loss Intervention Study

Cancers ◽

10.3390/cancers13133245 ◽

2021 ◽

Vol 13 (13) ◽

pp. 3245

Author(s):

Emma C. Atakpa ◽

Adam R. Brentnall ◽

Susan Astley ◽

Jack Cuzick ◽

D. Gareth Evans ◽

...

Keyword(s):

Body Mass Index ◽

Weight Loss ◽

Body Mass ◽

Breast Density ◽

Small Sample ◽

Weight Loss Intervention ◽

Short Term ◽

Dense Area ◽

Short Term Change ◽

Term Change

We evaluated the association between short-term change in body mass index (BMI) and breast density during a 1 year weight-loss intervention (Manchester, UK). We included 65 premenopausal women (35–45 years, ≥7 kg adult weight gain, family history of breast cancer). BMI and breast density (semi-automated area-based, automated volume-based) were measured at baseline, 1 year, and 2 years after study entry (1 year post intervention). Cross-sectional (between-women) and short-term change (within-women) associations between BMI and breast density were measured using repeated-measures correlation coefficients and multivariable linear mixed models. BMI was positively correlated with dense volume between-women (r = 0.41, 95%CI: 0.17, 0.61), but less so within-women (r = 0.08, 95%CI: −0.16, 0.28). There was little association with dense area (between-women r = −0.12, 95%CI: −0.38, 0.16; within-women r = 0.01, 95%CI: −0.24, 0.25). BMI and breast fat were positively correlated (volume: between r = 0.77, 95%CI: 0.69, 0.84, within r = 0.58, 95%CI: 0.36, 0.75; area: between r = 0.74, 95%CI: 0.63, 0.82, within r = 0.45, 95%CI: 0.23, 0.63). Multivariable models reported similar associations. Exploratory analysis suggested associations between BMI gain from 20 years and density measures (standard deviation change per +5 kg/m2 BMI: dense area: +0.61 (95%CI: 0.12, 1.09); fat volume: −0.31 (95%CI: −0.62, 0.00)). Short-term BMI change is likely to be positively associated with breast fat, but we found little association with dense tissue, although power was limited by small sample size.

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Higher body mass index is associated with larger postoperative improvement in patient-reported outcomes following total knee arthroplasty

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04512-1 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

K Giesinger ◽

JM Giesinger ◽

DF Hamilton ◽

J Rechsteiner ◽

A Ladurner

Keyword(s):

Body Mass Index ◽

Total Knee Arthroplasty ◽

Pain Relief ◽

Body Mass ◽

Knee Arthroplasty ◽

Normal Weight ◽

World Health ◽

Obese Patients ◽

Total Knee ◽

The Impact

Abstract Background Total knee arthroplasty is known to successfully alleviate pain and improve function in endstage knee osteoarthritis. However, there is some controversy with regard to the influence of obesity on clinical benefits after TKA. The aim of this study was to investigate the impact of body mass index (BMI) on improvement in pain, function and general health status following total knee arthroplasty (TKA). Methods A single-centre retrospective analysis of primary TKAs performed between 2006 and 2016 was performed. Data were collected preoperatively and 12-month postoperatively using WOMAC score and EQ-5D. Longitudinal score change was compared across the BMI categories identified by the World Health Organization. Results Data from 1565 patients [mean age 69.1, 62.2% women] were accessed. Weight distribution was: 21.2% BMI < 25.0 kg/m2, 36.9% BMI 25.0–29.9 kg/m2, 27.0% BMI 30.0–34.9 kg/m2, 10.2% BMI 35.0–39.9 kg/m2, and 4.6% BMI ≥ 40.0 kg/m2. All outcome measures improved between preoperative and 12-month follow-up (p < 0.001). In pairwise comparisons against normal weight patients, patients with class I-II obesity showed larger improvement on the WOMAC function and total score. For WOMAC pain improvements were larger for all three obesity classes. Conclusions Post-operative improvement in joint-specific outcomes was larger in obese patients compared to normal weight patients. These findings suggest that obese patients may have the greatest benefits from TKA with regard to function and pain relief one year post-op. Well balanced treatment decisions should fully account for both: Higher benefits in terms of pain relief and function as well as increased potential risks and complications. Trial registration This trial has been registered with the ethics committee of Eastern Switzerland (EKOS; Project-ID: EKOS 2020–00,879)

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P814 Independent association of body mass index and left atrial strain in patients with non valvular atrial fibrillation. The NeAfib-Echo registry

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.467 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

L Esposito ◽

R Sorrentino ◽

V Capone ◽

C Santoro ◽

M Lembo ◽

...

Keyword(s):

Atrial Fibrillation ◽

Body Mass Index ◽

Heart Rate ◽

Body Mass ◽

Left Atrial ◽

Longitudinal Strain ◽

Overweight And Obesity ◽

Volume Index ◽

The Third ◽

Lv Mass

Abstract Background Overweight and obesity are related to the risk of new-onset atrial fibrillation (AF). Peak atrial longitudinal strain (PALS) is an advanced echocardiographic parameter of left atrial (LA) function with a recognized diagnostic and prognostic role in both the general population and AF. Purpose To investigate the impact of body mass index (BMI) on LA function by utilizing standard and advanced echocardiography in patients with non-valvular AF. Methods In the NeAfib-Echo registry, 395 consecutive adult patients with non-valvular AF (F/M: 175/220; mean age 70.6 ± 11 years, BMI: 27.8 ± 5.6 kg/m²) were enrolled. 215 patients (54.1%) had permanent/persistent AF (prAF) and 178 (45.9%) had paroxysmal AF (pxAF). Anthropometric parameters and blood pressure (BP) were recorded and CHA2DS2VASc score was calculated. Patients underwent a complete echo-Doppler exam, including determination of PALS and left ventricular (LV) global longitudinal strain (GLS) (both reported in absolute values). The overall population was divided according to BMI tertiles: first tertile <25.3 Kg/m² (n = 127); second tertile 25.3-29 Kg/m² (n = 137); third tertile > 29.3 Kg/m² (n = 130). Results No significant difference of sex prevalence, age, systolic BP and heart rate was found among the three BMI tertiles, whereas diastolic BP was higher in the third tertile (p < 0.001). CHA2DS2VASc score did not significantly differ among tertiles. In the pooled population LV mass index (LVMi) (p = 0.001) progressively increased from the first to the third tertile (p < 0.001), whereas LA volume index, LV ejection fraction (EF), GLS and E/e" ratio were not significantly different among the three groups. PALS was lower in third tertile (14.3 ± 8.2%) versus both the first (19.0 ± 11.5%) and the second tertile (17.7 ± 10.6%) (p < 0.002). In separate sub-analyses according to AF type, PALS was significantly lower in the first than the third tertile in the PxAF group (p < 0.01) but not in patients with PrAF (p = 0.158). In the pooled population PALS was significantly related with BMI (r= -0.17, p < 0.001) (Figure) but also with age, heart rate, LVMi, LV EF, GLS, E/e’ ratio and pulmonary artery systolic pressure (PAPS). By a multilinear regression analysis, after adjusting for CHA2DS2VASc score, LV mass index, LV EF, E/e’ ratio and PAPs, BMI remained independently associated with PALS (standardized β coefficient = -0.127, p < 0.02) (cumulative R² =0.41, SEE = 8.5%, p < 0.0001). Conclusions In patients with non valvular AF, overweight and obesity exert a detrimental effect on LA function as testified by the gradual PALS reduction with the increase of BMI tertiles. BMI is associated with PALS independently of several confounders including CHA2DS2VASc. Besides CHA2DS2VASc score, BMI could be considered as an additional factor for evaluating cardiovascular risk in non valvular AF. Abstract P814 Figure. Relation between BMI and PALS

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Group-Based Trajectory Analysis of Physical Activity Change in a US Weight Loss Intervention

Journal of Physical Activity and Health ◽

10.1123/jpah.2017-0484 ◽

2018 ◽

Vol 15 (11) ◽

pp. 840-846 ◽

Cited By ~ 1

Author(s):

Christopher C. Imes ◽

Yaguang Zheng ◽

Dara D. Mendez ◽

Bonny J. Rockette-Wagner ◽

Meghan K. Mattos ◽

...

Keyword(s):

Physical Activity ◽

Body Mass Index ◽

Weight Loss ◽

Body Mass ◽

Behavioral Treatment ◽

Group Membership ◽

Multinomial Logistic Regression ◽

Step Count ◽

Weight Loss Intervention ◽

Trajectory Group

Background: The obesity epidemic is a global concern. Standard behavioral treatment including increased physical activity, reduced energy intake, and behavioral change counseling is an effective lifestyle intervention for weight loss. Purpose: To identify distinct step count patterns among weight loss intervention participants, examine weight loss differences by trajectory group, and examine baseline factors associated with trajectory group membership. Methods: Both groups received group-based standard behavioral treatment while the experimental group received up to 30 additional, one-on-one self-efficacy enhancement sessions. Data were analyzed using group-based trajectory modeling, analysis of variance, chi-square tests, and multinomial logistic regression. Results: Participants (N = 120) were mostly female (81.8%) and white (73.6%) with a mean (SD) body mass index of 33.2 (3.8) kg/m2. Four step count trajectory groups were identified: active (>10,000 steps/day; 11.7%), somewhat active (7500–10,000 steps/day; 28.3%), low active (5000–7500 steps/day; 27.5%), and sedentary (<5000 steps/day; 32.5%). Percent weight loss at 12 months increased incrementally by trajectory group (5.1% [5.7%], 7.8% [6.9%], 8.0% [7.4%], and 13.63% [7.0%], respectively; P = .001). At baseline, lower body mass index and higher perceived health predicted membership in the better performing trajectory groups. Conclusions: Within a larger group of adults in a weight loss intervention, 4 distinct trajectory groups were identified and group membership was associated with differential weight loss.

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Cancer Cachexia in the Age of Obesity: Skeletal Muscle Depletion Is a Powerful Prognostic Factor, Independent of Body Mass Index

Journal of Clinical Oncology ◽

10.1200/jco.2012.45.2722 ◽

2013 ◽

Vol 31 (12) ◽

pp. 1539-1547 ◽

Cited By ~ 949

Author(s):

Lisa Martin ◽

Laura Birdsell ◽

Neil MacDonald ◽

Tony Reiman ◽

M. Thomas Clandinin ◽

...

Keyword(s):

Skeletal Muscle ◽

Body Mass Index ◽

Weight Loss ◽

Body Mass ◽

Normal Weight ◽

Cancer Center ◽

Skeletal Muscle Index ◽

Patients With Cancer ◽

C Statistic ◽

Muscle Attenuation

Purpose Emerging evidence suggests muscle depletion predicts survival of patients with cancer. Patients and Methods At a cancer center in Alberta, Canada, consecutive patients with cancer (lung or GI; N = 1,473) were assessed at presentation for weight loss history, lumbar skeletal muscle index, and mean muscle attenuation (Hounsfield units) by computed tomography (CT). Univariate and multivariate analyses were conducted. Concordance (c) statistics were used to test predictive accuracy of survival models. Results Body mass index (BMI) distribution was 17% obese, 35% overweight, 36% normal weight, and 12% underweight. Patients in all BMI categories varied widely in weight loss, muscle index, and muscle attenuation. Thresholds defining associations between these three variables and survival were determined using optimal stratification. High weight loss, low muscle index, and low muscle attenuation were independently prognostic of survival. A survival model containing conventional covariates (cancer diagnosis, stage, age, performance status) gave a c statistic of 0.73 (95% CI, 0.67 to 0.79), whereas a model ignoring conventional variables and including only BMI, weight loss, muscle index, and muscle attenuation gave a c statistic of 0.92 (95% CI, 0.88 to 0.95; P < .001). Patients who possessed all three of these poor prognostic variables survived 8.4 months (95% CI, 6.5 to 10.3), regardless of whether they presented as obese, overweight, normal weight, or underweight, in contrast to patients who had none of these features, who survived 28.4 months (95% CI, 24.2 to 32.6; P < .001). Conclusion CT images reveal otherwise occult muscle depletion. Patients with cancer who are cachexic by the conventional criterion (involuntary weight loss) and by two additional criteria (muscle depletion and low muscle attenuation) share a poor prognosis, regardless of overall body weight.

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Appendicitis, Body Mass Index, and CT: Is CT More Valuable for Obese Patients than Thin Patients?

The American Surgeon ◽

10.1177/000313481107700425 ◽

2011 ◽

Vol 77 (4) ◽

pp. 471-475 ◽

Cited By ~ 4

Author(s):

Courtney A. Coursey ◽

Rendon C. Nelson ◽

Ricardo D. Moreno ◽

Mayur B. Patel ◽

Craig A. Beam ◽

...

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Normal Weight ◽

Morbidly Obese ◽

Negative Appendectomy ◽

Obese Patients ◽

Procedure Code ◽

Preoperative Ct ◽

The Difference ◽

Underweight Patients

The purpose of our study is to determine whether body mass index (BMI = weight in kg/height in meters2) was related to the rate of negative appendectomy in patients who underwent preoperative CT. A surgical database search performed using the procedure code for appendectomy identified 925 patients at least 18 years of age who underwent urgent appendectomy between January 1998 and September 2007. BMI was computed for the 703 of these 925 patients for whom height and weight information was available. Patients were stratified based on body mass index (BMI 15-18.49 = underweight; 18.5-24.9 = normal weight; 25–29.9 = overweight; 30-39.9 = obese; > 40 = morbidly obese). Negative appendectomy rates were computed. Negative appendectomy rates for patients who did and did not undergo preoperative CT were 27 per cent and 50 per cent for underweight patients, 10 per cent and 15 per cent for normal weight patients, 12 per cent and 17 per cent for overweight patients, 7 per cent and 30 per cent for obese patients, and 10 per cent and 100 per cent for morbidly obese patients. The difference in negative appendectomy rates for overweight patients, obese patients, and morbidly obese patients who underwent preoperative CT as compared with patients in the same BMI category who did not undergo preoperative CT was statistically significant ( P ≤ 0.001). The negative appendectomy rates for overweight patients, obese patients, and morbidly obese patients who underwent preoperative CT were significantly lower than for patients in these same BMI categories who did not undergo preoperative CT.

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A Conservative Weight Loss Intervention Relieves Bowel Symptoms in Morbidly Obese Subjects with Irritable Bowel Syndrome: A Prospective Cohort Study

Journal of Obesity ◽

10.1155/2018/3732753 ◽

2018 ◽

Vol 2018 ◽

pp. 1-9 ◽

Cited By ~ 7

Author(s):

Martin Aasbrenn ◽

Stian Lydersen ◽

Per G. Farup

Keyword(s):

Body Mass Index ◽

Morbid Obesity ◽

Weight Loss ◽

Irritable Bowel Syndrome ◽

Cohort Study ◽

Body Mass ◽

Prospective Cohort ◽

Weight Loss Intervention ◽

Bowel Symptoms ◽

Irritable Bowel

Background. Irritable bowel syndrome (IBS) is common in subjects with morbid obesity; the effect of weight loss programs on bowel symptoms is largely unknown. Methods. This prospective cohort study explored bowel symptoms, health scores, and biomarkers in subjects with morbid obesity during a six-month-long conservative weight loss intervention. Bowel symptoms were assessed with IBS-severity scoring system (IBS-SSS) and Gastrointestinal Symptom Rating Scale-IBS. Changes in all variables and associations between the changes in bowel symptoms and the other variables were analysed. Results. Eighty-eight subjects (81% females) were included. Body mass index was reduced from 42.0 (3.6) to 38.7 (3.5) (p<0.001). IBS-SSS was reduced from 116 (104) to 81 (84) (p=0.001). In all, 19 out of 25 variables improved significantly. In subjects with and without IBS at inclusion, the improvement in IBS-SSS was 88 (95% CI 55 to 121) and 10 (95% CI −9 to 29), respectively. Improved bowel symptoms were associated with improved subjective well-being, sense of humour, and vitamin D and negatively associated with reduced body mass index. Conclusion. Body mass index and health scores improved during a conservative weight loss intervention. Subjects with IBS before the intervention had a clinically significant improvement in bowel symptoms.

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Cardiac Changes in Overweight and Obese Patients

Romanian Journal of Internal Medicine ◽

10.1515/rjim-2016-0022 ◽

2016 ◽

Vol 54 (3) ◽

pp. 161-172 ◽

Cited By ~ 1

Author(s):

Teodora Gabriela Alexescu ◽

Angela Cozma ◽

Adela Sitar-Tăut ◽

V. Negrean ◽

M.I. Handru ◽

...

Keyword(s):

Body Mass Index ◽

Left Ventricle ◽

Diastolic Dysfunction ◽

Body Mass ◽

Body Surface ◽

Interventricular Septum ◽

Normal Weight ◽

The Body ◽

Obese Patients ◽

Left Ventricle Mass

Abstract Background. Obesity and overweight are two pathologies that are more and more frequent in the XXIst century diagnosis and are causing high morbidity and mortality rates in the general population, especially through cardiovascular complications.Aims. Identification and early diagnosis of cardiac changes in overweight and obese patients. Material and method. We carried out a sectional, analytical and observational study on 111 subjects: 27 normal weight subjects and 84 overweight and obese patients, which were submitted to a clinical exam, biochemical exams and 2D ultrasound.Results. The presence of diastolic dysfunction is twice more frequent in overweight patients in comparison to normal weight ones (30% vs 15%) and 5 times more frequent in obese patients than normal weight ones (75% vs 15%). The size increase of the interventricular septum is correlated with the body mass index, there being statistically significant differences between normal weight vs overweight vs obese patients, as well as between overweight and obese ones. Within the whole group and within the groups, both the left ventricle mass (g) as well as the left ventricle mass to body surface ratio (g/m²) are statistically significantly higher in patients with present diastolic dysfunction (E/A < 1). This indicates a relation between the presence of diastolic dysfunction, increased left ventricle mass and body mass index (p < 0.05).Conclusions. Overweight and obese patients, unlike normal weight ones, present early cardiac changes, such as: a decrease of left ventricle ejection fraction, diastolic dysfunction, thickening of the interventricular septum, increase of the left ventricle mass both per se as well as in ratio to body surface.

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An Analysis of the Potential Relationship of Triglyceride Glucose and Body Mass Index With Stroke Prognosis

Frontiers in Neurology ◽

10.3389/fneur.2021.630140 ◽

2021 ◽

Vol 12 ◽

Author(s):

Zongyi Hou ◽

Yuesong Pan ◽

Yindong Yang ◽

Xiaofan Yang ◽

Xianglong Xiang ◽

...

Keyword(s):

Body Mass Index ◽

Ischemic Stroke ◽

Body Mass ◽

Normal Weight ◽

Inverse Association ◽

Stroke Outcome ◽

Obese Patients ◽

Stroke Patients ◽

Tyg Index ◽

All Cause Mortality

Background: The inverse association between obesity and outcome in stroke patients (known as the obesity paradox) has been widely reported, yet mechanistic details explaining the paradox are limited. The triglyceride glucose (TYG) index has been proposed as a marker of insulin resistance. We sought to explore possible associations of the TYG index, body mass index (BMI), and stroke outcome.Methods: We identified 12,964 ischemic stroke patients without a history of diabetes mellitus from the China National Stroke Registry and classified patients as either low/normal weight, defined as a BMI <25 kg/m2, or overweight/obese, defined as a BMI ≥ 25 kg/m2. We calculated TYG index and based on which the patients were divided into four groups. A Cox or logistic regression model was used to evaluate the association between BMI and TYG index and its influence on stroke outcomes, including stroke recurrence all-cause mortality and poor outcome (modified Rankin Scale score of 3–6) at 12 months.Results: Among the patients, 63.3% were male, and 36.7% were female, and the mean age of the patient cohort was 64.8 years old. The median TYG index was 8.62 (interquartile range, 8.25–9.05). After adjusting for multiple potential covariates, the all-cause mortality of overweight/obese patients was significantly lower than that of the low/normal weight patients (6.17 vs. 9.32%; adjusted hazard ratio, 0.847; 95% CI 0.732–0.981). The difference in mortality in overweight/obese and low/normal weight patients with ischemic stroke was not associated with TYG index, and no association between BMI and TYG index was found.Conclusion: Overweight/obese patients with ischemic stroke have better survival than patients with low/normal weight. The association of BMI and stroke outcome is not changed by TYG index.

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Abstract 388: Body Mass Index Predicts Major leeding Risks in Patients on Warfarin

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvb.35.suppl_1.388 ◽

2015 ◽

Vol 35 (suppl_1) ◽

Author(s):

Adedotun A Ogunsua ◽

Sunkaru Touray ◽

Justin K Liu ◽

Jorge Escobar ◽

Tiffany Ip ◽

...

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Bleeding Event ◽

Bleeding Risk ◽

Normal Weight ◽

Class I ◽

Minor Bleeding ◽

Obese Patients ◽

Bleeding Events ◽

One Year

Background: Despite the lack of an optimum dosing strategy in obese patients, warfarin remains the most commonly used anticoagulant. Body mass index (BMI) > 30 has been linked to increased time to obtain a therapeutic institutionalized normalized ratio (INR) on initiation of warfarin as well as higher maintenance dose. Obese patients have higher dosage requirements, however, few studies have examined the relationship between warfarin and bleeding events in these patients. Aim: We examined the performance of BMI in predicting the incidence of bleeding at an anticoagulation clinic (ACC) over a one year period. Methods: 863 patients followed in an ACC were evaluated for bleeds according to BMI over a one year period. BMI was defined as weight (kg)/height (m2). CHADS2VASC scores were calculated. Major (gastrointestinal, intracerebral and retroperitoneal hemorrhage) and minor bleeding events (epistaxis, hematuria, vaginal and skin bleeds) were ascertained. Results: 71 ( 8.2%) of the 863 patients had a bleeding event, the mean age of the cohort was 69.5 years, and 44% were females. BMI categories were normal weight (21%), overweight (38%), obese class I, (21%), II (9 %), and III (11.3%) respectively. The prevalence of major and minor bleeding events were 35.2% and 64.8% respectively. In univariate analyses, hazard ratio for major bleeding risks increased with higher obesity categories (HR 1.30, 1.85, and 1.93 for class I,II, III respectively). In multivariable adjusted model, obesity (BMI>30) significantly increased the risk of major bleeds. (HR 1.84, P<.001) (Table 1). Conclusion: Bleeding risk is higher in obese compared to normal weight individuals who are on warfarin. Risk is higher with increasing BMI. This result suggests that BMI plays a role in bleeding events in patients on warfarin. Future studies are needed to understand the mechanism by which obesity increases bleeding risk for patients on warfarin and whether similar risk exist for the novel oral anticoagulants.

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