Aortic stenosis in obese patients

Czech version

Authors: Marianna Barbierik Vachalcová
Authors‘ workplace: I. kardiologická klinika LF UPJŠ a Východoslovenský ústav srdcových a cievnych chorôb., Košice
Published in: Forum Diab 2025; 14(2): 112-115
Category: Review Article

Overview

Obesity has been identified as a causal risk factor for the development of aortic stenosis (AS), with both increased body mass index (BMI) and abdominal obesity, expressed as waist circumference, demonstrably increasing the risk of its development. Available epidemiological and clinical studies confirm a direct link between increased BMI and the incidence of AS, pointing to the potential role of metabolic and pro-inflammatory mechanisms in the pathogenesis of the disease. Surprisingly, in patients with established severe AS, obesity has been associated with a better prognosis in some studies, a phenomenon known as the “obesity paradox.” This observation highlights the need for further research into the pathophysiological mechanisms and clinical consequences of obesity in the context of AS, with the aim of optimizing risk stratification and therapeutic approaches.

Keywords:

obesity – Prognosis – obesity paradox – body mass index – waist circumference – aortic stenosis – cardio-vascular risk

Sources

Eveborn GW, Schirmer H, Heggelund G et al. The evolving epidemiology of valvular aortic stenosis. The Tromsø Study. Heart 2013; 99(6): 396–400. Dostupné z DOI: <http://dx.doi.org/10.1136/heartjnl-2012–302265>-

Chakos A, Wilson-Smith A, Arora S et al. Long term outcomes of transcatheter aortic valve implantation (TAVI): a systematic review of 5-year survival and beyond. Ann Cardiothorac Surg 2017; 6(5): 432–443. Dostupné z DOI: <http://dx.doi.org/10.21037/acs.2017.09.10>.

Osnabrugge RL, Mylotte D, Head SJ et al. Aortic stenosis in the elderly: disease prevalence and number of candidates for transcatheter aortic valve replacement: a meta-analysis and modeling study. J Am Coll Cardiol 2013; 62 : 1002–1012. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jacc.2013.05.015>.

Stewart BF, Siscovick D, Lind BK et al. Clinical factors associated with calcific aortic valve disease. J Am Coll Cardiol 1997; 29(3): 630–634. Dostupné z DOI: <http://dx.doi.org/10.1016/s0735–1097(96)00563–3>.

Katz R, Wong ND, Kronmal R et al. Features of the metabolic syndrome and diabetes mellitus as predictors of aortic valve calcification in the Multi-Ethnic Study of Atherosclerosis Circulation 2006; 113(17): 2113–2119. Dostupné z DOI: <http://dx.doi.org/10.1161/CIRCULATIONAHA.105.598086>.

Stritzke J, Linsel-Nitschke P, Markus MR et al. Association between degenerative aortic valve disease and long-term exposure to cardiovascular risk factors: results of the longitudinal population-based KORA/MONICA survey. Eur Heart J 2009; 30(16): 2044–2053. Dostupné z DOI: <http://dx.doi.oirg/10.1093/eurheartj/ehp287>.

Larsson SC, Wolk A, Hakansso N et al. Overall and abdominal obesity and incident aortic valve stenosis: two prospective cohort studies. Eur Heart J 2017; 38(28): 2192–2197. Dostupné z DOI: <http://dx.doi.org/10.1093/eurheartj/ehx140>.

Yu Chen H, Dina C, Small AM et al. Dyslipidemia, inflammation, calcification, and adiposity in aortic stenosis: a genome-wide study. Eur Heart J 2023; 44(21): 1927–1939. Dostupné z DOI: <http://dx.doi.org/10.1093/eurheartj/ehad142>.

Otto CM, Newby DE, Hillis GS. Calcific Aortic Stenosis: A Review. JAMA 2024; 332(23): 2014–2026. Dostupné z DOI: http://dx.doi.org/10.1001/jama.2024.16477>.

Small AM, Yutzey KE, Binstadt BA et al. Unraveling the Mechanisms of Valvular Heart Disease to Identify Medical Therapy Targets: A Scientific Statement From the American Heart Association. Circulation 2024; 150(6): e109-e128. Dostupné z DOI: <http://dx.doi.org/10.1161/CIR.0000000000001254>.

Conte M, Petraglia L, Campana P et al. The role of inflammation and metabolic risk factors in the pathogenesis of calcific aortic valve stenosis. Aging Clin Exp Res 2021; 33(7): 1765–1770. Dostupné z DOI: <http://dx.doi.org/10.1007/s40520–020–01681–2>.

Cho KI, Sakuma I, Sohn IS et al. Inflammatory and metabolic mechanisms underlying the calcific aortic valve disease. Atherosclerosis 2018; 277 : 60–65. Dostupné z DOI: <http://dx.doi.org/10.1016/j.atherosclerosis.2018.08.029>.

Huang N, Zhuang Z, Liu Z et al. Observational and Genetic Associations of Modifiable Risk Factors with Aortic Valve Stenosis: A Prospective Cohort Study of 0.5 Million Participants. Nutrients 2022; 14(11): 2273. Dostupné z DOI: <http://dx.doi.org/10.3390/nu14112273>.

Kaltoft M, Langsted A, Nordestgaard BG. Obesity as a Causal Risk Factor for Aortic Valve Stenosis. J Am Coll Cardiol 2020; 75(2): 163–176. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jacc.2019.10.050>.

Larsson SC, Wolk A, Håkansson N et al. Overall and abdominal obesity and incident aortic valve stenosis: two prospective cohort studies. Eur Heart J 2017; 38(28): 2192–2197. Dostupné z DOI: <http://dx.doi.org/10.1093/eurheartj/ehx140>.

Om SY, Ko E, Ahn JM et al. Relation of Body Mass Index to Risk of Death or Stroke in Patients Who Underwent Transcatheter Aortic Valve Implantation. Am J Cardiol 2019; 123(4): 638–643. Dostupné z DOI: <http://dx.doi.org/10.1016/j.amjcard.2018.11.015>.

Bruno VD, Chivasso P, Rapetto F et al. Impact of Body Mass Index on Short -⁠ and Long-Term Outcomes After Isolated First-Time Surgical Aortic Valve Replacement for Aortic Stenosis. J Cardiothorac Vasc Anesth 2019; 33(11): 2995–3000. Dostupné z DOI: <http://dx.doi.org/10.1053/j.jvca.2019.02.015>.

González-Ferreiro R, Muñoz-García AJ, López-Otero D et al. Prognostic value of body mass index in transcatheter aortic valve implantation: A “J”-shaped curve. Int J Cardiol 2017; 232 : 342–347. Dostupné z DOI: <http://dx.doi.org/10.1016/j.ijcard.2016.12.051>.

Lv W, Li S, Liao Y et al. The ‘obesity paradox’ does exist in patients undergoing transcatheter aortic valve implantation for aortic stenosis: a systematic review and meta-analysis. Interact Cardiovasc Thorac Surg 2017; 25(4): 633–642. Dostupné z DOI: <http://dx.doi.org/10.1093/icvts/ivx191>.

Wernio E, Jagielak D, Dardzińska JA et al. Analysis of Outcomes of the Nutritional Status in Patients Qualified for Aortic Valve Replacement in Comparison to Healthy Elderly. Nutrients 2018; 10(3): 304. Dostupné z DOI: <http://dx.doi.org/10.3390/nu10030304>.

Chew NW, Zhang A, Kong G et al. Prognostically Distinct Phenotypes of Metabolic Health Beyond Obesity in Aortic Stenosis. Am J Cardiol 2022; 178 : 112–118. Dostupné z DOI: <http://dx.doi.org/10.1016/j.amjcard.2022.05.018>.

Lin S, Liu C, Ding X et al. Body composition of metabolically unhealthy normal-weight patients with aortic stenosis: a prospective cohort study. BMC Cardiovasc Disord 2024; 24(1): 739. Dostupné z DOI: <http://dx.doi.org/10.1186/s12872–024–04400–1>.

Powell-WileyTM, Poirier P, Burke LE et al. Obesity and Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation 2021; 143(21g): e984-e1010. Dostupné z DOI: <http://dx.doi.org/10.1161/CIR.0000000000000973>.

Lavie CJ, McAuley PA, Church TS et al. Obesity and cardiovascular diseases: implications regarding fitness, fatness, and severity in the obesity paradox. J Am Coll Cardiol 2014; 63(14): 1345–1354. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jacc.2014.01.022>.

Carbone S, Canada JM, Billingsley HE et al. Obesity paradox in cardiovascular disease: where do we stand? Vasc Health Risk Manag 2019; 15 : 89–100. Dostupné z DOI: <http://dx.doi.org/10.2147/VHRM.S168946>.

Bianchettin RG, Lavie CJ, Lopez-Jimenez F. Challenges in Cardiovascular Evaluation and Management of Obese Patients: JACC State-of-the-Art Review. J Am Coll Cardiol 2023; 81(5): 490–504. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jacc.2022.11.031>.

Baumgartner H, Hung J, Bermejo J et al. Recommendations on the Echocardiographic Assessment of Aortic Valve Stenosis: A Focused Update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. J Am Soc Echocardiogr 2017; 30(4): 372–392. Dostupné z DOI: <http://dx.doi.org/10.1016/j.echo.2017.02.009>.

Praz F, Borger MA, Lanz J et al. ESC/EACTS Scientific Document Group. 2025 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 2025: ehaf194. Dostupné z DOI: <http://dx.doi.org/10.1093/eurheartj/ehaf194>.