Aziza Azimi

Moderate overweight is beneficial and severe obesity detrimental for patients with documented atherosclerotic heart disease

Objective Obesity is paradoxically associated with enhanced survival in patients with established cardiovascular disease. We explored this paradox further by examining the influence of obesity on survival in patients with verified atherosclerotic heart disease. Design and patients This retrospective registry based cohort study included all patients from the Western Denmark Heart Registry with coronary atherosclerosis confirmed by coronary angiography from January 2000 to December 2010. Patients were divided into eight groups according to body mass index (BMI) based on WHO BMI classification. Setting Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark. Results The study included 37 573 patients (70.7% men) with a mean age of (66.3±11.1) years. During the 11 years of follow-up, 5866 (15.6%) patients died. Multivariable analysis confirmed that the risk of death was the lowest among the preobese patients (27.5≤BMI<30 kg/m2) with adjusted HR of 0.82 (95% CI 0.71 to 0.95; p=0.008) and increased with both low (BMI<18.50 kg/m2) and very high (BMI≥40 kg/m2) BMI, HR 2.04 (95% CI 1.63 to 2.57; p<0.001) and HR 1.35 (95% CI 1.05 to 1.72; p<0.01), respectively. Also the normal weight class I (18.5≤BMI<23 kg/m2) had a significant risk of mortality HR 1.28 (95% CI 1.13 to 1.45; p<0.001). Obese classes I and II did not differ from the reference group (23≤BMI<25 kg/m2). Conclusions Overweight atherosclerotic heart disease patients have improved survival compared with normal weight patients. Underweight and severely obese patients have increased mortality. Our results lean more towards an overweight paradox than an obesity paradox.

Prepregnancy Obesity and Associations With Stroke and Myocardial Infarction in Women in the Years After Childbirth A Nationwide Cohort Study

Background— Cardiovascular events (stroke or myocardial infarction) are often associated with poorer prognosis in younger, compared with older individuals. We examined the associations between prepregnancy obesity and the risks of myocardial infarction and stroke in young, healthy women. Methods and Results— All Danish women giving birth during 2004–2009 without a history of renal disease or cardiovascular disease were identified from national registers and followed for a median time of 4.5 years (interquartile range, 2.8–5.8). They were grouped according to prepregnancy body mass index (BMI) in underweight (BMI<18.5 kg/m2), normal weight (BMI=18.5–<25 kg/m2), overweight (BMI=25–<30 kg/m2), and obese (BMI≥30 kg/m2). The hazard ratios of myocardial infarction, ischemic stroke, and a composite outcome (myocardial infarction, stroke, cardiovascular death) were assessed using multivariable Cox regression models. We included 273 101 women with a median age of 30.4 years (interquartile range, 27.2–33.8). A total of 68 women experienced a myocardial infarction, and 175 women experienced an ischemic stroke. The adjusted hazard ratios of myocardial infarction compared with normal weight were 2.50 (95% confidence interval [95% CI], 0.97–6.50) in underweight, 1.68 (95% CI, 0.92–3.06) in overweight, and 2.63 (95% CI, 1.41–4.91) in obese women. For ischemic stroke the adjusted hazard ratios were 1.06 (95% CI, 0.44–2.28) in underweight, 1.27 (95% CI, 0.87–1.85) in overweight, and 1.89 (95% CI, 1.25–2.84) in obese women, respectively. For the composite outcome, hazard ratios were 1.34 (95% CI, 0.81–2.20), 1.43 (95% CI, 1.11–1.84), and 1.76 (95% CI, 1.31–2.34) for underweight, overweight, and obese women. Conclusions— In apparently healthy women of fertile age, prepregnancy obesity was associated with increased risks of ischemic stroke and myocardial infarction in the years after childbirth.

Risk factors for venous thromboembolism during pregnancy

Pregnant women are at an increased risk of venous thromboembolism (VTE). Risk factors for VTE among pregnant women are not sufficiently investigated.

Initiation and Persistence with Warfarin Therapy in Atrial Fibrillation According to Ethnicity

The aim of this study was to investigate initiation of and persistence with warfarin treatment in patients with atrial fibrillation (AF) according to ethnicity. Patients hospitalized with first-time AF from 1997 to 2009, prescription claims of warfarin and country of birth were identified by individual-level linkage of nationwide administrative agencies. Cox proportional hazards models were used to estimate the relationship between covariates affecting initiation and non-persistence with warfarin treatment. A total of 151,537 patients were included in the study and 5,061(3.3%) were of non-Danish origin. CHADS2 score distribution varied substantially according to ethnicity, the proportion of patients with CHADS2 score ≥1 being 79.2, 78.1, 65.9, and 46.0% for patients of Danish, Western, Eastern, and African origin, respectively. 79,239(52.4%) of all patients initiated treatment with warfarin at some point in time. Multivariable Cox proportional hazard analyses indicated patients of Eastern and African origin were less likely to initiate warfarin therapy (HR 0.75; 95% CI 0.69–0.82 and HR 0.58; 95% CI 0.44–0.76, respectively). Patients of Eastern origin were more likely to interrupt treatment (HR 1.23; 95% CI 1.02–1.47; for all patients; HR 1.62; 95% CI 1.22–2.16; for patients with CHADS2 score >1). African origin was associated with a trend to interrupt treatment (HR 1.44; 95% CI 0.46–4.47; for patients with CHADS2 score >1). Initiation of and persistence with warfarin in AF patients is lower among patients of Eastern and African origin compared to patients of Danish and Western origin, despite equal access to health care and medication. Future studies should address, beyond ethnicity, all possible driving factors of (non)initiation and persistence with treatment in general. This will be particularly interesting in light of the new generation of anticoagulants, which might render different adherence to treatment.

Prepregnancy Obesity and Associations With Stroke and Myocardial Infarction in Women in the Years After Childbirth

Background— Cardiovascular events (stroke or myocardial infarction) are often associated with poorer prognosis in younger, compared with older individuals. We examined the associations between prepregnancy obesity and the risks of myocardial infarction and stroke in young, healthy women. Methods and Results— All Danish women giving birth during 2004–2009 without a history of renal disease or cardiovascular disease were identified from national registers and followed for a median time of 4.5 years (interquartile range, 2.8–5.8). They were grouped according to prepregnancy body mass index (BMI) in underweight (BMI<18.5 kg/m2), normal weight (BMI=18.5–<25 kg/m2), overweight (BMI=25–<30 kg/m2), and obese (BMI≥30 kg/m2). The hazard ratios of myocardial infarction, ischemic stroke, and a composite outcome (myocardial infarction, stroke, cardiovascular death) were assessed using multivariable Cox regression models. We included 273 101 women with a median age of 30.4 years (interquartile range, 27.2–33.8). A total of 68 women experienced a myocardial infarction, and 175 women experienced an ischemic stroke. The adjusted hazard ratios of myocardial infarction compared with normal weight were 2.50 (95% confidence interval [95% CI], 0.97–6.50) in underweight, 1.68 (95% CI, 0.92–3.06) in overweight, and 2.63 (95% CI, 1.41–4.91) in obese women. For ischemic stroke the adjusted hazard ratios were 1.06 (95% CI, 0.44–2.28) in underweight, 1.27 (95% CI, 0.87–1.85) in overweight, and 1.89 (95% CI, 1.25–2.84) in obese women, respectively. For the composite outcome, hazard ratios were 1.34 (95% CI, 0.81–2.20), 1.43 (95% CI, 1.11–1.84), and 1.76 (95% CI, 1.31–2.34) for underweight, overweight, and obese women. Conclusions— In apparently healthy women of fertile age, prepregnancy obesity was associated with increased risks of ischemic stroke and myocardial infarction in the years after childbirth.

Prepregnancy Obesity and Associations With Stroke and Myocardial Infarction in Women in the Years After ChildbirthCLINICAL PERSPECTIVE: A Nationwide Cohort Study

Background— Cardiovascular events (stroke or myocardial infarction) are often associated with poorer prognosis in younger, compared with older individuals. We examined the associations between prepregnancy obesity and the risks of myocardial infarction and stroke in young, healthy women. Methods and Results— All Danish women giving birth during 2004–2009 without a history of renal disease or cardiovascular disease were identified from national registers and followed for a median time of 4.5 years (interquartile range, 2.8–5.8). They were grouped according to prepregnancy body mass index (BMI) in underweight (BMI<18.5 kg/m2), normal weight (BMI=18.5–<25 kg/m2), overweight (BMI=25–<30 kg/m2), and obese (BMI≥30 kg/m2). The hazard ratios of myocardial infarction, ischemic stroke, and a composite outcome (myocardial infarction, stroke, cardiovascular death) were assessed using multivariable Cox regression models. We included 273 101 women with a median age of 30.4 years (interquartile range, 27.2–33.8). A total of 68 women experienced a myocardial infarction, and 175 women experienced an ischemic stroke. The adjusted hazard ratios of myocardial infarction compared with normal weight were 2.50 (95% confidence interval [95% CI], 0.97–6.50) in underweight, 1.68 (95% CI, 0.92–3.06) in overweight, and 2.63 (95% CI, 1.41–4.91) in obese women. For ischemic stroke the adjusted hazard ratios were 1.06 (95% CI, 0.44–2.28) in underweight, 1.27 (95% CI, 0.87–1.85) in overweight, and 1.89 (95% CI, 1.25–2.84) in obese women, respectively. For the composite outcome, hazard ratios were 1.34 (95% CI, 0.81–2.20), 1.43 (95% CI, 1.11–1.84), and 1.76 (95% CI, 1.31–2.34) for underweight, overweight, and obese women. Conclusions— In apparently healthy women of fertile age, prepregnancy obesity was associated with increased risks of ischemic stroke and myocardial infarction in the years after childbirth.

Prepregnancy Obesity and Associations With Stroke and Myocardial Infarction in Women in the Years After ChildbirthCLINICAL PERSPECTIVE

Background— Cardiovascular events (stroke or myocardial infarction) are often associated with poorer prognosis in younger, compared with older individuals. We examined the associations between prepregnancy obesity and the risks of myocardial infarction and stroke in young, healthy women. Methods and Results— All Danish women giving birth during 2004–2009 without a history of renal disease or cardiovascular disease were identified from national registers and followed for a median time of 4.5 years (interquartile range, 2.8–5.8). They were grouped according to prepregnancy body mass index (BMI) in underweight (BMI<18.5 kg/m2), normal weight (BMI=18.5–<25 kg/m2), overweight (BMI=25–<30 kg/m2), and obese (BMI≥30 kg/m2). The hazard ratios of myocardial infarction, ischemic stroke, and a composite outcome (myocardial infarction, stroke, cardiovascular death) were assessed using multivariable Cox regression models. We included 273 101 women with a median age of 30.4 years (interquartile range, 27.2–33.8). A total of 68 women experienced a myocardial infarction, and 175 women experienced an ischemic stroke. The adjusted hazard ratios of myocardial infarction compared with normal weight were 2.50 (95% confidence interval [95% CI], 0.97–6.50) in underweight, 1.68 (95% CI, 0.92–3.06) in overweight, and 2.63 (95% CI, 1.41–4.91) in obese women. For ischemic stroke the adjusted hazard ratios were 1.06 (95% CI, 0.44–2.28) in underweight, 1.27 (95% CI, 0.87–1.85) in overweight, and 1.89 (95% CI, 1.25–2.84) in obese women, respectively. For the composite outcome, hazard ratios were 1.34 (95% CI, 0.81–2.20), 1.43 (95% CI, 1.11–1.84), and 1.76 (95% CI, 1.31–2.34) for underweight, overweight, and obese women. Conclusions— In apparently healthy women of fertile age, prepregnancy obesity was associated with increased risks of ischemic stroke and myocardial infarction in the years after childbirth.