Association of lean body mass and fat mass with peripheral arterial disease events in hypertensive patients

Background and aim: Some studies have suggested a negative correlation between obesity and peripheral arterial disease (PAD), a phenomenon known as the obesity paradox. Some have suggested that this phenomenon occurs due to the inability of the body mass index (BMI), a commonly used indicator of obesity, to differentiate between lean body mass (LBM) and fat mass (FM). We attempted to investigate the relationship between LBM and FM in relation to PAD events, respectively. Methods and results: This post hoc analysis was conducted using data from the Systolic Blood Pressure Intervention Trial (SPRINT), and we employed Cox proportional hazards regression to investigate the relationship of LBM and FM with incident PAD. After an average follow-up of 3.7 years for 9285 participants, the study found that 5989 were male and 3296 were female. A total of 172 had an outcome event. We found a significant negative correlation between FMI and PAD events hazard ratio (HR) 0.70, 95% confidence interval (CI) 0.56–0.86, while there was a significant positive correlation between LBMI and PAD events (HR 1.56, 95% CI 1.19–2.05). A restricted cubic spline analysis also confirmed this relationship, and it was consistent across the different subgroups. Conclusions: In hypertensive patients, higher FM may be associated with a lower risk of PAD events, whereas higher LBM may be related to a higher risk of PAD events. The obesity paradox in PAD events may not be attributed to BMI's inability to distinguish between LBM and FM.