Association of Body Mass Index With Risk Factor Optimization and Guideline-Directed Medical Therapy in US Veterans With Cardiovascular Disease

The relation between estimated pulse wave velocity and peripheral arterial disease: A study based on NHANES

BACKGROUND

As a type of atherosclerotic lesion affecting the peripheral vascular system, peripheral arterial disease (PAD) has an elevated disability rate and seriously affects patients' quality of life. Estimated pulse wave velocity (ePWV) is an alternative indicator of pulse wave velocity and is closely linked with atherosclerosis. However, the link between ePWV and PAD is unelucidated.

OBJECTIVES

This research was undertaken to dissect the linkage between ePWV and PAD.

METHODS

This project enrolled 6250 participants in the NHANES between 1999 and 2004. The linkage between ePWV and PAD and its possible influencing factors were explored by constructing a weighted logistics regression model and subgroup analysis. In addition, the threshold effect analysis and restricted cubic spline (RCS) model were utilized to evaluate the non-linear link.

RESULTS

The weighted logistic regression model demonstrated a great positive linkage between ePWV and PAD risk in the fully adjusted model (OR = 1.29, 95% CI: 1.18-1.42, p < .001). There was a significant nonlinear link between ePWV and PAD. When ePWV was higher than 9.297, the risk of PAD increased significantly (OR = 1.03, 95% CI: 1.02-1.04, p < .001). No significant linkage was detected when the value was below this threshold. Additionally, the subgroup analysis further demonstrated that ePWV had a stronger positive link with PAD in the elderly population (age ≥60 years) and in people with BMI ≤30.

CONCLUSION

ePWV is an effective predictor of PAD risk especially in the elderly and non-obese population.

Obesity and Peripheral Artery Disease: Current Evidence and Controversies

PURPOSE OF REVIEW

Obesity is a significant public health problem and a major risk factor for the development and progression of atherosclerosis and its cardiovascular manifestations. Lower extremity peripheral artery disease (PAD) affects 3%-10% of the Western population and, if left untreated, can lead to devastating outcomes with both an increased risk of morbidity and mortality. Interestingly, the association between obesity and PAD remains debatable. Whereas it is well known that PAD and obesity frequently overlap in the same patients, many studies have demonstrated a negative association between obesity and PAD and a protective effect of obesity on disease development and progression, a phenomenon described as the "obesity paradox." Possible mechanisms for this paradox may include genetic background, as assessed by mendelian randomization studies, adipose tissue dysfunction, and body fat distribution rather than adiposity, while other factors, such as sex, ethnicity, sarcopenia in the elderly population, or aggressive treatment of co-existing metabolic conditions in individuals with obesity compared to those with normal weight, could have some impact as well.

RECENT RINDINGS

Few reviews and meta-analyses examining systematically the relationship between obesity and PAD exist. The impact of PAD development due to the presence of obesity remains largely controversial. However, the most current evidence, backed by a recent meta-analysis, suggests a potential protective role of a higher body mass index on PAD-related complications and mortality. In this review, we discuss the association between obesity and PAD development, progression, and management, and the potential pathophysiologic mechanisms linking the two diseases.

Alirocumab efficacy and safety by body mass index: A pooled analysis from 10 Phase 3 ODYSSEY trials

AIMS

Increased body mass index (BMI) contributes to cardiovascular risk and may influence efficacy of therapeutic antibodies. We investigated the effect of baseline BMI on efficacy and safety of alirocumab, a PCSK9 monoclonal antibody.

METHODS

In a post-hoc analysis, data were pooled from 10 Phase 3 trials (n=4975) of alirocumab vs. placebo/ezetimibe controls. Alirocumab dose was 150mg every 2 weeks in two trials, and 75mg every 2 weeks with possible increase to 150mg at 12 weeks (based on Week 8 low-density lipoprotein cholesterol [LDL-C]) in eight trials. Efficacy/safety data were assessed in baseline BMI subgroups of≤25,>25 to 30,>30 to 35, and>35kg/m².

RESULTS

Baseline LDL-C levels were lower among patients in the higher BMI subgroups. Significant LDL-C reductions from baseline were observed at Weeks 12 and 24 for alirocumab vs. controls, of similar magnitude regardless of baseline BMI (interaction P-value=0.7119). LDL-C<1.81mmol/L (<70mg/dL) was achieved at Week 24 by 69.8-76.4% of alirocumab-treated patients and 9.7-18.4% of control-treated patients, with no pattern by BMI. A greater proportion of patients in higher vs. lower BMI subgroups required alirocumab dose increase (P=0.0343); proportions were 22.5%, 24.9%, 31.7%, and 27.2% of patients across BMI subgroups of≤25,>25 to 30,>30 to 35, and>35kg/m², respectively. Adverse event frequencies were similar regardless of BMI; injection-site reaction frequency was higher with alirocumab (5.1-8.2% across BMI categories) vs. controls (3.6-4.8%).

CONCLUSIONS

Alirocumab provided consistent LDL-C reductions, with similar safety findings across BMI subgroups.