In anticoagulated patients with AF, the conicity index demonstrated the strongest and consistent prognostic value among all adiposity indices, and its integration into conventional risk scores may enhance risk stratification in this high-risk population.
Key Findings
Results
High conicity index (C-index >1.34) was the only adiposity index independently associated with thromboembolic events in anticoagulated AF patients.
Adjusted hazard ratio (aHR) of 2.29 (95% CI: 1.58, 3.34) for thromboembolic events compared with the low C-index group
2070 consecutive AF outpatients were enrolled between January 2016 and November 2021
18.1% of patients experienced a thromboembolic event during follow-up
The association was identified using multivariable Cox models with C-index as a categorical variable
Results
High C-index (>1.34) was independently associated with major bleeding and clinically relevant non-major bleeding (MB/CRNMB).
aHR of 2.10 (95% CI: 1.58, 2.79) for MB/CRNMB compared with the low C-index group
13.5% of patients experienced MB/CRNMB during follow-up
This association was independent of other covariates in multivariable models
No other adiposity index showed independent association with MB/CRNMB
Results
High C-index (>1.34) was independently associated with major adverse cardiovascular events (MACE).
aHR of 2.48 (95% CI: 1.79, 3.43) for MACE compared with the low C-index group
11.3% of patients suffered a MACE during follow-up
The C-index showed the highest discriminative performance for all primary outcomes among all adiposity indices tested
Results
High C-index was also associated with cardiovascular and all-cause mortality as secondary outcomes.
Both cardiovascular death and all-cause death were evaluated as secondary outcomes
The association with mortality held after multivariable adjustment
This extended the prognostic relevance of C-index beyond primary cardiovascular and bleeding outcomes
Results
The C-index showed a nonlinear relationship with adverse outcomes, while all other adiposity indices showed linear associations.
Restricted cubic spline (RCS) analysis was used to assess the shape of associations between adiposity indices and outcomes
Adiposity indices evaluated included BMI, conicity index, weight-adjusted waist index, waist-to-height ratio, body roundness index, and a body shape index
Only the C-index demonstrated a nonlinear relationship with adverse outcomes in RCS analysis
Results
The discriminative performance of C-index for all primary outcomes improved further when integrated with CHA2DS2-VASc and HAS-BLED scores.
Receiver operating characteristic analyses were used to assess discriminative performance
Integration of C-index with CHA2DS2-VASc and HAS-BLED enhanced risk stratification beyond either score alone
The C-index consistently showed the highest discriminative performance among all adiposity indices tested for all primary outcomes
Methods
The study population was predominantly elderly and female, with a relatively short follow-up period.
Total of 2070 patients enrolled; 52.8% female
Median age was 77 years (interquartile range: 70–83)
Mean follow-up was 1.8 years (standard deviation: 0.5)
All patients were AF outpatients initiating oral anticoagulation
Soler-Espejo E, Chen Y, Roldán V, Marín F, Rivera-Caravaca J, Lip G. (2026). Prognostic value of adiposity indices in anticoagulated patients with atrial fibrillation: the prospective Murcia AF Project III cohort.. The American journal of clinical nutrition. https://doi.org/10.1016/j.ajcnut.2025.101184