Valvular & structural heart diseaseCohort study
Clarifying the Obesity Paradox in Transcatheter Aortic Valve Replacement
- retrospective analysis of the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry
- Inverse probability of treatment weighting regression models
Authors' conclusion
Higher BMI was not uniformly protective. Among older adults, lower BMI was associated with a higher-risk phenotype and worse 1-year outcomes.
Study context
- Population
- Patients who underwent transcatheter aortic valve replacement (TAVR) between January 2021 and February 2023, categorized by age (<65 or ≥65 years) and body mass index (BMI) (<25 or ≥25 kg/m²)mean age 76.7 ± 11.6 years, mean BMI 29.7 ± 9.9 kg/m²
- Participants
- 6,639 patients
- Exposure
- BMI <25 kg/m² vs BMI ≥25 kg/m², by age
- Outcome
- 1-year all-cause mortality
- Follow-up
- 1 year
Main finding
As reported in the abstract
Adjusted hazard ratio
1.29
95% CI 1.05–1.57
P = 0.013
BMI <25 kg/m² vs BMI ≥25 kg/m²
aHR 1.29 (95% CI 1.05–1.57); P = 0.013
- 1-year all-cause mortality occurred in 427 patients
- 427 (6.4%)
Observational data: associations, not effects.
Secondary outcomes
| Outcome | aHR (95% CI) | P value | |
|---|---|---|---|
| Major adverse cardiovascular and cerebrovascular events · 1 year · patients ≥65 years | 1.20 (1.08–1.34) | P = 0.001 | |
| Mortality with higher BMI, by age stratum — higher BMI vs BMI ≥25 kg/m² | 0.60 (0.44–0.82) | P = 0.001 | |
| Mortality with higher BMI, by age stratum — higher BMI vs BMI ≥25 kg/m² | 0.36 (0.25–0.51) | P < 0.001 | |
| 0.20.5125Adjusted hazard ratio (log scale) |
- Mortality with higher BMI, by age stratum: patients 75 to 84 years; higher BMI associated with lower mortality
- Mortality with higher BMI, by age stratum: patients ≥85 years; higher BMI associated with lower mortality
Mortality with higher BMI, by age stratum
- Association strengthened with advancing age; not significant in younger strata
Original publication
Clarifying the Obesity Paradox in Transcatheter Aortic Valve Replacement. JACC Adv. Published 9 July 2026. doi:10.1016/j.jacadv.2026.102985
Summarised from the published abstract; every number is checked against it