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17583

Obesity In Adults with Congenital Heart Disease: Double Jeopardy?

Friday, October 19, 2012
Room 275-277 (Morial Convention Center)
Abhishek M. Mewada, MD, Medicine-Pediatrics, Wayne State University - Detroit Medical Center, Detroit, MI, Manit Singla, Internal Medicine, Detroit Medical Center, Detroit, MI and Sanjeev Aggarwal, MD, Division of Cardiology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI

Purpose: Obesity is a modifiable, independent risk factor for adverse long-term cardiac outcomes. Many children with congenital heart defects (CHD) are now surviving to adulthood. Adults with repaired CHD may be particularly prone to develop obesity due to limited exercise capacity. The prevalence of obesity in this population is unknown. Our objective was to determine the prevalence of obesity and overweight status in a cohort of adults with congenital heart disease, in comparison with normal published data and to examine associated factors.

Methods: This was a retrospective chart review of patients > 18 years of age, who presented to the Pediatric Cardiology clinic at our institution. Body mass index (BMI) was calculated on each patient, using standard formulae. Overweight status was defined as BMI of 25 to 29.9 and obesity was defined as BMI ≥ 30. Subjects were divided into three age groups according to the NHANES database classification: 18-39, 40-59 and above 60 years of age.

Results: Our cohort comprised 290 subjects, 167 (57.6 %) of whom were males and 190 (65.5%) were Caucasians. Their age (mean ±SD) was 29.8 ±11.3 years and diagnoses included simple PFO/ASD device closure in 16.6%, simple heart disease (VSD, AI) 21.4%, moderate heart disease (repaired TOF, AV canal) 21.4%, severe heart disease (Fontan and Mustard palliation) 32.7% and primary arrhythmias in 7.9%. The mean BMI was 26.3 ±6.7. As a group, 8.3% were underweight, 41% were normal, 27.6% overweight and 23.1% patients were obese. The prevalence of overweight status and obesity were comparable in males and females (29.9 vs. 24.4 and 21 vs. 26.8 respectively). The prevalence of combined obesity and overweight was higher in African-Americans compared to Caucasians (55.6% vs. 49.5%). The prevalence of combined overweight and obesity in both genders is lower in our cohort compared to NHANES (1999-2010) data (50.7% vs. 69.2%); these lower rates are seen in all age groups

Table: Comparison of prevalence of overweight status and obesity in adults with CHD and published NHANES rates in normal population

 

Men

Women

 

NHANES (%)

Study Cohort (%)

N=167

NHANES (%)

Study Cohort (%)

N=123

Overall

74.1

50.9

64.5

51.2

18-39 yrs (n=236)

67.1

47.4

55.8

50.4

40-59 yrs (n=46)

79.5

57.7

66.0

45

≥ 60 yrs (n=8)

76.5

100

73.5

100

Conclusions: Although lower than NHANES prevalence rate, about 50% of our cohort of adults with repaired congenital heart disease was overweight or obese. In addition, the 8.3% prevalence of underweight status in our cohort is alarming and may suggest progression of underlying disease and heart failure. Weight management interventions should be emphasized in this population. It is plausible that stringent weight control may improve outcomes in adults with repaired congenital heart disease.