• Jason Weatherald, Alice Huertas, Athénaïs Boucly, Christophe Guignabert, Yu Taniguchi, Yochai Adir, Mitja Jevnikar, Laurent Savale, Xavier Jaïs, Mingkai Peng, Gérald Simonneau, David Montani, Marc Humbert, and Olivier Sitbon.
• Department of Medicine, Division of Respirology, University of Calgary, Calgary, AB, Canada; Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France; Service de Pneumologie, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France; INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France; Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada. Electronic address: jcweathe@ucalgary.ca.
• Chest. 2018 Oct 1; 154 (4): 872-881.

BackgroundAn obesity paradox, wherein patients who are obese have lower mortality, has been described in cardiopulmonary diseases, including pulmonary arterial hypertension (PAH). Our objective was to determine whether obesity and BMI are associated with mortality in patients with PAH.MethodsWe assessed incident patients with idiopathic, drug-induced, and heritable PAH from the French Pulmonary Hypertension Network registry. Cox regression and Kaplan-Meier analysis were used to assess the association between BMI and obesity with all-cause mortality.ResultsOf 1,255 patients included, 30% were obese. A higher proportion of women (65.1% vs 53.4%, P < .01), drug-induced PAH (28.9% vs 9.2%, P < .01), systemic hypertension, diabetes, and hypothyroidism were present in the obese group. More obese patients were in New York Heart Association class III (66.4% vs 57.1%), fewer were class IV (11.8% vs 16.9%, P < .01), and 6-min walk distance was lower (276 ± 121 vs 324 ± 146, P < .01). Right atrial pressure, pulmonary wedge pressure, and cardiac index were higher, whereas pulmonary vascular resistance was lower in patients who were obese. Neither BMI (hazard ratio [HR], 0.99; 95% CI, 0.97-1.01; P = .41) nor obesity (HR, 1.0; 95% CI, 0.99-1.01; P = .46) were associated with mortality in multivariable analyses. There was a significant interaction between age and obesity such that mortality increased among patients < 65 years of age who were morbidly obese (HR, 3.01; 95% CI, 1.56-5.79; P = .001).ConclusionsObesity was not associated with mortality in the overall population, but there was an age-obesity interaction with increased mortality among young patients who were morbidly obese. These results have implications for active weight management in younger patients who are morbidly obese who are otherwise candidates for lung transplantation.Copyright © 2018 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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