Introduction The obesity paradox has been seen in many cardiovascular conditions. The goal of this study was to evaluate whether it exists in patients with a diagnosis of aortic stenosis.

Method We used the Nationwide Inpatients Sample (NIS) database and ICD-10 coding for adults in different weight categories and with aortic stenosis diagnoses for 2016-2020. We evaluated the effect of weight on mortality using multivariate adjustment and the cox-regression model.

Results A total of 2,330,584 patients were diagnosed with aortic stenosis. Mortality was lowest in overweight followed by obesity and morbid obesity (1.74% vs. 2.43% vs 3.2% in comparison to normal weight mortality of 4.4%, p<0.001) and it was highest in patients with cachexia (mortality of 14.5%). After adjusting for baseline characteristics and comorbid conditions, the relation between mortality and weights remained unaltered. Multivariate adjusted odds ratios (OR) were as follows: Overweight OR 0.4, CI 0.31-0.6, p<0.001, Obesity: OR 0.64, CI 06-0.68, p<0.001, morbid obesity OR: 0.88, CI 0.83-0.94, P<0.001, Cachexia OR 3.31 CI: 3.04-3.62, p<0.001).

Conclusion Using the largest database, we found that in patients with a diagnosis of aortic stenosis, overweight followed by obesity and morbid obesity have the lowest mortality whereas cachexia has the highest mortality compared to normal-weight patients.

The authors have declared no competing interest.

no funding

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We used NIS data base

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