Sex Differences in Association between Abdominal Obesity and Cardiovascular Death in Patients with Permanent Pacemaker Implantation: a Retrospective Cohort Study

Objective: This study aimed to explore the associations between abdominal obesity and cardiovascular death (CVD) in patients with permanent pacemakers (PPMs) implantation and to investigate the role of gender on the possible associations. In this regard, this study investigated the association between waist circumference (WC) and cardiovascular death in patients with permanent pacemakers (PPMs) implantation. Methods This was a retrospective cohort study that included the data of patients who underwent PPMs implantation in Fuwai Hospital, China from May 2010 to April 2014 using BIOTRONIK Home Monitoring® database. Waist circumference was classified into sex-specific quartiles and patients were divided into three groups according to their body mass index (BMI) values: normal (≤ 22.9 kg/m 2 ), overweight (23–24.9 kg/m 2 ), and obese (≥ b25 kg/m 2 ). Cox proportional hazards models were used to calculate the hazard ratios and 95% confidence intervals for cardiovascular death based on the patient’s WC and BMI. Results A total of 492 patients with PPMs implantation were analyzed (mean age: 71.9 ± 10.8 years; 55.1% men [n = 271]). Data showed that after a mean follow-up period of 67.2 ± 17.5 months, 24 (4.9%) patients had experienced cardiovascular death and 71 (14.4%) were cases of all-cause mortality. The men in the third quartile of WC had a hazard ratio (HR) of 10.67 (Model 4, 95% CI: 1.00–115.21, P-trend = 0.04) for cardiovascular death. However, the association disappeared in the women patients (Model 4, HR = 3.99, 95% CI: 0.37–42.87, P-trend = 0.25). No association was found between BMI and cardiovascular death or all-cause mortality in both men and women patients. Conclusions Abdominal obesity was associated with an increased risk of cardiovascular death in patients with PPMs and this association is gender dependence where only men patients show this association.