Obesity remains a significant public health challenge, with at least one in eight people living with the condition. Individuals with obesity are at a heightened risk for many serious health conditions, ranging from breathing problems and joint problems to cardiovascular disease. In the United States, obesity-related cardiovascular disease deaths tripled between 1999 and 2023.
“While obesity is a major risk factor for cardiovascular disease, it is also unfortunately tied to many factors that may be out of an individual’s control, like their socio-economic status, family history, or geographical location,” said SCAI President James B. Hermiller, MD, MSCAI. “New research at SCAI’s 2025 Scientific Sessions aims to understand how obesity plays a role in the prevalence and progression of heart conditions, with the hope of improving early intervention tools and disease screenings for all patients with obesity.”
Research Challenges Common Perception of Patients with Obesity and Critical Limb Ischemia
CLI is a severe form of peripheral artery disease (PAD) that is characterized by significant blood flow blockages in the arms, legs, or feet that may lead to heart complications or amputation. Since individuals with obesity and PAD have a significantly higher chance of developing CLI, three to five times more likely, the study aimed to uncover if the obesity paradox, the understanding that individuals with obesity may have better health outcomes than those with a normal weight, plays a role in clinical outcomes of CLI patients.
Investigators conducted a retrospective analysis of CLI patients using the National Inpatient Sample (NIS) Database from 2019-2022. The data pool included 4,177,213 patients admitted for CLI. Of this pool, 59,030 (1.4%) patients were non-obese, with an average age of 59 years, and 1,142,519 (27.35%) patients were obese, with an average age of 68 years.
Findings uncovered that the obesity paradox does exist, as CLI patients with a higher body mass index (BMI) were associated with lower mortality and additional negative outcomes. The primary outcome of the research was in-hospital death, and data found that the non-obese group saw a higher death rate, almost twice as high (0.045 vs 0.023). The non-obese group also saw an increase in secondary outcomes in comparison to the obese group, which researchers selected as total hospital charges ($100,773 vs. $82,963), length of hospital stay (9.8 vs 7.8 days), endovascular repair (6.4% vs. 2.7%), surgical repair (1.8% vs 0.6%), major amputations (65% vs. 27%), and vascular complications (0.5% vs. 0.3%). However, there was no difference between groups for minor amputation.
“Our team was surprised to find obesity in CLI patients is linked to lower death rates along with shorter hospital stays, reduced hospital costs, fewer repairs, and lower instances of major amputation,” said Albert Alexis Annan, MD, Texas Health Harris Methodist Hospital Hurst Euless Bedford in Bedford, Texas and lead author of the study. “This data challenges the common perception that patients with obesity tend to have worse health outcomes, though we hope to emphasize the importance of seeking proper care and implementing appropriate and timely interventions regardless.”
Future studies to better understand the obesity paradox in CLI patients are warranted to improve decision-making in clinical settings.
Premature Cardiac Arrest Mortality Has Surged 273% in Patients with Obesity Since 2003
Obesity remains a significant yet modifiable risk factor for premature cardiac arrest. Despite this condition accounting for just over one-third of deaths in individuals under age 70 worldwide, there is a lack of research seeking to understand its association with mortality in individuals with obesity. This study aims to focus on common disparities, as findings suggest there is a significant increase in premature cardiac arrest among adults with obesity, specifically in Black, American Indian, and non-metropolitan communities.
In a retrospective analysis using the CDC WONDER dataset from 1999-2020, researchers pulled individuals aged between 25-65 years. Patients with obesity who died were identified and divided by time, sex, race, and geography.
Data showed that premature cardiac arrest was responsible for 57,871 deaths among adults with obesity, with the death rate increasing almost fourfold over two decades (from 0.79 to 2.95 per 100,000 people). Females showed a lower death rate (1.25) than males (1.72), though both groups saw a noticeable rise in death rate throughout the study duration. When accounting for race, Black Americans had the highest mortality rate (2.75), followed by American Indians (2.27), Whites (1.4), then Hispanic or Latinos (1.17). Asians had the lowest death rate (0.47). Geographic differences were also notable, as Maryland had the lowest death rate per state (0.61), while Mississippi had the highest per state (3.98). Large cities also had lower death rates (1.40) than smaller towns (2.02) and rural areas (1.90).
“Given the advancements in cardiovascular care during our study duration, we were surprised to find that premature cardiac arrest deaths in patients with obesity increased. This dramatic increase, combined with profound variations in race and geographical location, highlights the fact that significant differences still exist despite overall improvements in healthcare,” said Muhammad Ahmad, MBBS, Khyber Medical College in Peshawar, Pakistan, and lead author of the study. “Our findings emphasize an urgent need to better allocate resources to high-risk groups in the communities that need it the most.
This abstract is published in the SCAI Abstract Supplement, which appears in SCAI’s official journal, JSCAI. You can access it here: https://doi.org/10.1016/j.jscai.2025.102761.
Heart Attack and Obesity Related Deaths Related to Obesity Increase by 30% – With Higher Rates in Midwest, Rural, and Black American Communities
AMI, or a heart attack, affects more than 800,000 Americans each year. While it is well known that patients with obesity are at an increased risk of AMI mortality, the association between AMI and obesity-related mortality in adults aged 25 and older has not yet been investigated. This study found there was an increase in AMI and obesity-related mortality, with notable racial and geographic disparities.
Through an analysis of CDC WONDER mortality data, researchers pulled death rates per 100,000 from 2007 to 2019 and examined trends by year, sex, race, state, region, and city status.
Data found that both AMI and obesity contributed to 44,599 deaths, with the death rate rising 30%, from 1.2 to 1.7 over the course of twelve years. Women had a lower mortality rate (1.1) than men (1.9). Racial disparities showed that Black Americans had the highest death rate (1.9), followed by American Indians/Alaska Natives (1.8), White (1.6), Hispanic/Latino (0.9), and Asian/Pacific Islander (0.3). When observing geographical location, Wyoming had the highest death rate (3.7), followed by Arkansas (3.3), and South Dakota (3.2); and orienting by region showed the Midwest region with the highest mortality rate (1.7). Additionally, non-metropolitan areas like suburbs, small towns, and rural areas had a higher death rate (2.4) than cities (1.3).
“Our results show concerning trends, further emphasizing how clinicians should prioritize screenings, early interventions, and tailored prevention strategies to reduce disparities and improve outcomes among high-risk populations,” said lead author of the study Farhan Naeem, MD, Massachusetts General Hospital in Boston.
Additional research is needed to further address and mitigate these concerning trends.
This abstract is published in the SCAI Abstract Supplement, which appears in SCAI’s official journal, JSCAI. You can access it here: https://doi.org/10.1016/j.jscai.2025.102837
Session Details:
“The Obesity Paradox and Critical Limb Ischemia – An Analysis of the National Inpatient Sample”
Saturday, May 3, 2025; 10:25-11:45 AM ET
Walter E. Washington Convention Center, SCAI Central, Hall D
“Rising Trends in Premature Cardiac Arrest Mortality Among Adults with Obesity: A 22-Year Retrospective Analysis”
Thursday, May 1, 2025; 10:45 AM - 12:00 PM ET
Walter E. Washington Convention Center, SCAI Central, Hall D
“Trends in Acute Myocardial Infarction and Obesity-Related Mortality in the United States, 2007-2019"
Thursday, May 1, 2025; 10:45 AM - 12:00 PM ET
Walter E. Washington Convention Center, Hall D: Theater 1
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About Society for Cardiovascular Angiography & Interventions (SCAI)
The Society for Cardiovascular Angiography & Interventions, established in 1978, stands as the primary nonprofit medical society dedicated to representing invasive and interventional cardiology. SCAI's mission is to guide the global interventional cardiovascular community by fostering education, advocacy, research, and upholding standards for quality patient care. For more than 40 years, SCAI has exemplified professional excellence and innovation worldwide, cultivating a reputable community of over 5,000 members committed to advancing medical science and providing life-saving care for individuals, both adults and children, affected by cardiovascular disease. For more information, visit https://scai.org/.
For more information about the SCAI 2025 Scientific Sessions, visit https://scai.org/scai-2025-scientific-sessions. Follow @SCAI on X (formerly Twitter) and on LinkedIn for the latest heart health news and use #SCAI2025 to follow the latest discussions.
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