Impact of Gait Speed on the Obesity Paradox in Older Patients with Cardiovascular Disease.

［Original Article］

Nakamura T, Kamiya K, Matsunaga A, Hamazaki N, Matsuzawa R, Nozaki K, Yamashita M, Maekawa E, Noda C, Yamaoka-Tojo M, Ako J. Am J Med. 2019 Jul 26. pii: S0002-9343(19)30595-9.

OBJECTIVE:To determine whether gait speed affects the obesity paradox in older cardiovascular disease patients.

METHODS:The study population consisted of 2224 patients ≥60years old with cardiovascular disease admitted to hospital between May 1, 2006 and January 31, 2018. Body mass index (BMI) and gait speed before hospital discharge were determined, and patients were divided into slow and preserved gait speed (≤0.8 and>0.8m/s, respectively) groups according to the algorithm for sarcopenia diagnosis. The slow and preserved gait speed groups were also further subdivided according to BMI: BMI<18.5kg/m2, BMI 18.5 to 24.9kg/m2, and BMI≥25.0kg/m2. The study endpoint was all-cause mortality.

RESULTS:The study population (male: 66.7%) had a mean age of 73.1±7.6years. Over a median follow-up period of 1.69years (interquartile range 0.67-3.67years), 283 patients died. Higher BMI was associated with favorable prognosis in the preserved gait speed group but not in the slow gait speed group after adjusting for other prognostic factors. Adding BMI to the clinical model significantly increased the area under the receiver operating characteristic curve in the preserved gait speed group (0.744 vs. 0.726, P=0.028) but not in the slow gait speed group (0.716 vs. 0.716, P=0.789).

CONCLUSIONS:Higher BMI was consistently associated with favorable prognosis in cardiovascular disease patients with preserved gaitspeed but not in those with slow gait speed. These findings indicated that physical frailty influences the obesity paradox in older patients with cardiovascular disease.

PMID: 31356768