Introduction

Obesity is a known variable associated with increased risk of atrial fibrillation (AF); however, the impact of body mass index (BMI) on adverse cardiovascular outcomes in individuals with AF taking anticoagulants is not well established.

Aim of the research

This study aimed to evaluate the association between BMI categories (normal weight, overweight, and obese) and adverse cardiovascular outcomes in individuals with AF taking anticoagulants.

Material and methods

This prospective, observational, long-term follow-up cohort study included 500 individuals with AF who underwent transoesophageal echocardiography before electrical cardioversion. Individuals were stratified by BMI and followed up for a median of 1927.5 days. Endpoints included major cardiovascular events (stroke, myocardial infarction, transient ischaemic attack, systemic thromboembolism, hospitalisation for heart failure, and cardiovascular death) and left atrial appendage thrombus (LAAT).

Results

Adverse cardiovascular event rates were similar across BMI categories. Individuals with normal weight presented with fewer comorbidities, such as diabetes mellitus and arterial hypertension, and demonstrated more favourable echocardiographic measurements, including smaller left atrial diameters. Despite these differences, no significant variations in LAAT prevalence or other adverse cardiovascular outcomes were observed between the BMI groups. BMI did not significantly influence long-term adverse cardiovascular outcomes or LAAT in individuals with AF taking anticoagulants. The low proportion of normal-weight individuals in the cohort suggests a potential protective role of normal weight against AF.

Conclusions

Further research is required to understand the complex interplay among BMI, comorbidities, and cardiovascular risk. These findings question the utility of BMI as a standalone risk predictor in this population.