Obesity in pulmonary arterial hypertension the pulmonary hypertension association registry

Jeff Min, Rui Feng, David Badesch, Erika Berman-Rosenzweig, Charles Burger, Murali Chakinala, Teresa De Marco, Jeremy Feldman, Anna Hemnes, Evelyn M. Horn, Matthew Lammi, Stephen Mathai, John W. McConnell, Kenneth Presberg, Jeffrey Robinson, Jeffrey Sager, Oksana Shlobin, Marc Simon, Thenappan Thenappan, Corey VentetuoloNadine Al-Naamani

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


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.

Original languageEnglish
Pages (from-to)229-237
Number of pages9
JournalAnnals of the American Thoracic Society
Issue number2
StatePublished - Feb 1 2021


  • Hospitalization
  • Obesity
  • Pulmonary arterial hypertension
  • Quality of life
  • Survival analysis


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