{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T12:24:08Z","timestamp":1753878248612,"version":"3.41.2"},"reference-count":21,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2023,12,14]],"date-time":"2023-12-14T00:00:00Z","timestamp":1702512000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Diabetes"],"published-print":{"date-parts":[[2024,7]]},"abstract":"Abstract<\/jats:title>Background<\/jats:title>The primary objective was to determine the influence of obesity and associated metabolic status on clinical outcomes of Asian patients with atrial fibrillation (AF).<\/jats:p><\/jats:sec>Methods<\/jats:title>This study was based on a prospective multicenter of patients with nonvalvular AF. Patients were classified as obese and nonobese and being metabolic unhealthy was defined as having at least one of the three cardiovascular risk factors including dyslipidemia, hypertension, or diabetes mellitus. Outcomes were a primary composite outcome of all\u2010cause death, ischemic stroke\/systemic embolism (SSE), acute myocardial infarction (MI), and heart failure (HF), as well as the individual end points.<\/jats:p><\/jats:sec>Results<\/jats:title>There were a total of 3141 enrolled patients (mean age 67.4\u2009\u00b1 11.1\u2009years; 41.0% female), of whom 1566 (49.9%) were obese and 2564 (81.6%) were metabolic unhealthy. During a mean follow\u2010up of 32.2\u2009\u00b1\u20098.3\u2009months, the incidence rate of the composite outcome, all\u2010cause death, SSE, MI, and HF were 7.21 (6.63\u20137.82), 3.86 (3.45\u20134.30), 1.48 (1.23\u20131.77), 0.47 (0.33\u20130.64), and 2.84 (2.48\u20133.23) per 100 person\u2010years, respectively. Metabolic unhealthy nonobese subjects were at higher risk of the composite outcomes than metabolic unhealthy obese subjects with hazard ratio (HR) 1.39, 95% confidence interval (CI) 1.17\u20131.66, p<\/jats:italic>\u2009<\u2009.001. Metabolic unhealthy obese subjects tend to have an increased risk of the composite outcomes compared to those metabolic healthy obese (HR 1.36, 95% CI 0.91\u20132.02, p<\/jats:italic>\u2009=\u2009.133). Metabolic healthy obese subjects were not associated with increased risk.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>Metabolic unhealthy obese subjects were associated with an increased risk of adverse outcomes in AF patients, whereas metabolically healthy obesity was not associated with an increased risk.<\/jats:p>image<\/jats:alt-text><\/jats:graphic><\/jats:boxed-text><\/jats:p><\/jats:sec>","DOI":"10.1111\/1753-0407.13519","type":"journal-article","created":{"date-parts":[[2023,12,14]],"date-time":"2023-12-14T11:38:12Z","timestamp":1702553892000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical outcomes of obese and nonobese patients with atrial fibrillation according to associated metabolic abnormalities: A report from the COOL\u2010AF<\/scp> registry"],"prefix":"10.1111","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8684-2361","authenticated-orcid":false,"given":"Rungroj","family":"Krittayaphong","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thanita","family":"Boonyapiphat","sequence":"additional","affiliation":[{"name":"Lampang Hospital Lampang Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arjbordin","family":"Winijkul","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory Y. H.","family":"Lip","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital Liverpool UK"},{"name":"Danish Center for Clinical Health Services Research, Department of Clinical Medicine Aalborg University Aalborg Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,12,14]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnut.2020.00053"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.2147\/VHRM.S168946"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000973"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurjpc\/zwac187"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.116.015984"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)15268-3"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.3803\/EnM.2020.772"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-022-05803-5"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0040-1716408"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0041-1739411"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa612"},{"key":"e_1_2_11_13_1","article-title":"Adherence to the \u2018atrial fibrillation better care' pathway in patients with atrial fibrillation: impact on clinical outcomes\u2010a systematic review and meta\u2010analysis of 285,000 patients","volume":"23","author":"Romiti GF","year":"2021","journal-title":"Thromb Haemost"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/dom.14492"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2011-3475"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv486"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.292.20.2471"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2009.11.026"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1038\/ijo.2017.99"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehw124"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(01)01448-6"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1038\/ijo.2013.203"}],"container-title":["Journal of Diabetes"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1753-0407.13519","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,29]],"date-time":"2024-07-29T08:55:26Z","timestamp":1722243326000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1753-0407.13519"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,14]]},"references-count":21,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2024,7]]}},"alternative-id":["10.1111\/1753-0407.13519"],"URL":"https:\/\/doi.org\/10.1111\/1753-0407.13519","archive":["Portico"],"relation":{},"ISSN":["1753-0393","1753-0407"],"issn-type":[{"type":"print","value":"1753-0393"},{"type":"electronic","value":"1753-0407"}],"subject":[],"published":{"date-parts":[[2023,12,14]]},"assertion":[{"value":"2023-08-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-11-26","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-12-14","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e13519"}}