Obesity may be associated with a greater risk for pulmonary hypertension (PH), which may be associated with increased mortality, according to a study published in the Journal of the American Heart Association.
A total of 8940 consecutive patients (mean age, 62 years; 40% women) who underwent right-sided heart catherization between 2005 and 2016 at Massachusetts General Hospital were included in this study. PH was defined as mean pulmonary artery pressure >20 mm Hg, and was classified as precapillary, postcapillary, or mixed PH. The association between body mass index (BMI) and pulmonary vascular hemodynamics was assessed using multivariable regression models. In this cohort, 52% and 69% of nonobese and obese patients, respectively had PH. There was an independent association between higher BMI and greater odds of overall PH (odds ratio [OR], 1.34; 95% CI, 1.29–1.40; P <.001 per 5-unit increase in body mass index), precapillary PH (OR, 1.18; 95% CI, 1.11–1.25; P <.001), postcapillary PH (OR, 1.36; 95% CI, 1.29–1.43; P <.001), and mixed PH (OR, 1.50; 95% CI, 1.41–1.58; P <.001).
The presence of PH was also associated with a greater risk for mortality (hazard ratio [HR], 2.01; 95% CI, 1.82–2.22; P <.001). Among patients with PH, obesity was associated with a 23% lower hazard of mortality (HR, 0.77; 95% CI, 0.69–0.85; P <.001). The presence of obesity was found to modify the effect of PH on mortality (P for interaction =.02), particularly in patients with precapillary PH (HR, 0.57; 95% CI, 0.46–0.70; P <.001). Study limitations include its observational nature, and the inclusion of a higher number of PH cases in the cohort than is typically observed in the general population.
“Further studies are needed to elucidate mechanisms underlying obesity-related PH and factors influencing clinical outcomes,” concluded the study authors.
Frank RC, Min J, Abdelghany M, et al. Obesity Is associated with pulmonary hypertension and modifies outcomes. J Am Heart Assoc. 2020;9(5):e014195.