The association of obesity with cardiovascular events in patients with peripheral artery disease

Objectives: This systematic review aimed to summarise published evidence that has assessed the association of obesity with major cardiovascular events (CVEs) (non-fatal myocardial infarction, non-fatal stroke, cardiovascular death) in patients with peripheral artery disease (PAD). Methods: Studies investigating the association of markers of obesity with CVEs were identified by searching the PUBMED database. To be eligible for inclusion studies had to report an established measure of adiposity, i.e. body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) or an imaging technique to quantify adipose distribution. Results: A total of 9319 patients with PAD were followed for a mean of 1.0–5.7 years in the 7 studies identified. Four studies assessed BMI; one study assessed BMI and WC; one study assessed BMI, WC and WHR; one study assessed WHR. Both of the studies which assessed multiple adipose measures reported a more powerful positive association of WC with CVEs than BMI; one study reported less CVEs in obese subjects as defined by BMI; one study reported a negative association of overweight but not obesity, defined by BMI, with CVEs; one study reported an inverse association of BMI >20 with CVEs; one study did not find a significant association between WHR and cardiovascular death; one study did not find a significant association between BMI and CVEs. Meta-analysis of reported risk ratios found a mild positive association between combined measures of obesity and CVEs in patients with PAD (RR 1.09; 95%CI 1.03–1.16, P = 0.006; random effects model). Conclusion: This meta-analysis suggests that obesity is an independent risk factor for CVEs in patients with PAD however larger and more homogeneous studies using equivalent anthropometric measures are needed for more definitive evidence