Impact of Gait Speed on the Obesity Paradox in Older Patients With Cardiovascular Disease

Abstract

Purpose: The purpose of this study was to determine whether gait speed affects the obesity paradox in older patients with cardiovascular disease.

Methods: The study population consisted of 2224 patients ≥60 years old with cardiovascular disease admitted to hospital between May 1, 2006, and January 31, 2018. Body mass index (BMI) and gait speed before hospital discharge were determined, and patients were divided into two groups: slow and preserved gait speed (≤0.8 and >0.8 m/s, respectively), according to the algorithm for sarcopenia diagnosis. The slow and preserved gait speed groups were also further subdivided according to BMI: <18.5 kg/m², 18.5-24.9 kg/m², and BMI ≥25.0 kg/m². The study endpoint was all-cause mortality.

Results: The study population (male: 66.7%) had a mean age of 73.1 ± 7.6 years. Over a median follow-up period of 1.69 years (interquartile range 0.67-3.67 years), 283 patients died. Higher BMI was associated with favorable prognosis in the group with preserved gait speed but not in the group with slow gait speed after adjusting for other prognostic factors. Adding BMI to the clinical model significantly increased the area under the receiver operating characteristic curve in the group with preserved gait speed (0.744 vs 0.726, P = 0.028) but not in the group with slow gait speed (0.716 vs 0.716, P = 0.789).

Conclusions: Higher BMI was consistently associated with favorable prognosis in patients with cardiovascular disease and preserved gait speed but not in those with slow gait speed. These findings indicated that physical frailty influences the obesity paradox in older patients with cardiovascular disease.

Keywords: Cardiovascular disease; Gait speed; Obesity paradox; Older; Prognosis.