Rationale: Obesity is associated with pulmonary arterial hypertension (PAH), but its impact on outcomes such as health-related quality of life (HRQoL), hospitalizations, and survival is not well understood. Objectives: To assess the effect of obesity on HRQoL, hospitalizations, and survival in patients with PAH. Methods: We performed a cohort study of adults with PAH from the Pulmonary Hypertension Association Registry, a prospective multicenter registry. Multivariate linear mixed-effects regression was used to examine the relationship between weight categories and HRQoL using the Short Form-12 and emPHasis-10. We used multivariable negative binomial regression to estimate hospitalization incidence rate ratios (IRRs) and Cox regression to estimate hazard ratios (HRs) for transplant-free survival by weight status. Results: A total of 767 subjects were included (mean age of 57 years, 74% female, 33% overweight, and 40% with obesity), with median follow-up duration of 527 days. Overweight patients and patients with obesity had higher baseline emPHasis-10 scores (worse HRQoL), which persisted over time (P<0.001). Patients who are overweight and obese have a trend toward increased incidence of hospitalizations compared with normalweight patients (IRR, 1.34; 95% confidence interval [95% CI], 0.94- 1.92 and IRR, 1.33; 95% CI 0.93-1.89, respectively). Overweight patients and patients with obesity had lower risk of transplant or death compared with normal-weight patients (HR, 0.45; 95% CI, 0.25-0.80 and HR, 0.39; 95% CI, 0.22-0.70, respectively). Conclusions: In a large multicenter, prospective cohort of PAH, patients who were overweight or obese had worse disease-specific HRQoL despite better transplant-free survival compared with normal-weight patients. Future interventions should address the specific needs of these patients.
Bibliographical noteFunding Information:
A complete list of additional PHAR Investigators may be found before the beginning of the REFERENCES. Supported by the U.S. National Institutes of Health K23 HL141584, Aldrighetti Research Award for Young Investigators. Author Contributions: N.A.-N. was responsible for the conception and design of the work. J.M., R.F., and N.A.-N. were responsible for the analysis of the data. J.M., R.F., D.B., E.B.-R., C.B., M.C., T.D.M., J.F., A.H., E.M.H., M.L., S.M., J.W.M., K.P., J.R., J.S., O.S., M.S., T.T., C.V., and N.A.-N. made contributions to the acquisition of and interpretation of the data and drafting and revising the manuscript for important intellectual content. All authors were responsible for ensuring the accuracy and integrity of the work and have given final approval for its publication.
Acknowledgment: The Pulmonary Hypertension Association Registry (PHAR) is supported by Pulmonary Hypertension Care Centers, Inc., a supporting organization of the Pulmonary Hypertension Association. The authors thank the other investigators, the staff, and particularly the participants of the PHAR for their valuable contributions. A full list of participating PHAR sites and institutions can be found at www.PHAssociation.org/PHAR.
© 2021 by the American Thoracic Society.
- Pulmonary arterial hypertension
- Quality of life
- Survival analysis