Clarifying the Obesity Paradox in Transcatheter Aortic Valve Replacement

BACKGROUND: Higher body mass index (BMI) has been associated with better outcomes after transcatheter aortic valve replacement (TAVR), but whether this "obesity paradox" varies by age is unclear. OBJECTIVES: The objective of the study was to determine whether age modifies the association between BMI and 1-year outcomes after TAVR. METHODS: ). The primary outcome was 1-year all-cause mortality. Secondary outcomes included major adverse cardiovascular and cerebrovascular events: stroke, cardiac mortality, myocardial infarction, and readmission. Inverse probability of treatment weighting regression models were used to assess outcomes. RESULTS: . The association between higher BMI and lower mortality strengthened with advancing age and was significant in patients 75 to 84 years (aHR: 0.60; 95% CI: 0.44-0.82; P = 0.001) and ≥85 years (aHR: 0.36; 95% CI: 0.25-0.51; P < 0.001), but not in younger strata. CONCLUSIONS: Higher BMI was not uniformly protective. Among older adults, lower BMI was associated with a higher-risk phenotype and worse 1-year outcomes.