Body-Weight Fluctuations and Coronary Disease Outcomes

Study Questions:

Do fluctuations in body weight increase risk for coronary events or death among patients with a history of coronary artery disease (CAD)?

Methods:

Data from the Treating to New Targets Trial were used for the present analysis. Changes in body weight were calculated using baseline weight and repeat measures taken during follow-up visits. Body-weight variability was measured according to average successive variability and used in multivariate models as a time-dependent covariate. The primary outcome was any coronary event (a composite of death from coronary heart disease, nonfatal myocardial infarction [MI], resuscitated cardiac arrest, revascularization, or angina). Secondary outcomes were any cardiovascular (CV) event (a composite of any coronary event, a cerebrovascular event, peripheral vascular disease, or heart failure), death, MI, or stroke.

Results:

A total of 9,509 participants were included in the present analysis. The mean baseline weight of the patients was 85 ± 15 kg. The median time between the first and last measurements of weight was 4.7 years with a median number of weight measurements of 12 (range, 2-14). The median body-weight variability was 1.76 kg. Those with low body weight variability were more likely to be older, female, currently smoking, and have chronic kidney disease, and less likely to be diabetic, hypertensive, or have known heart failure. After adjustment for risk factors, baseline lipid levels, mean body weight, and weight change, each increase of 1 standard deviation was associated with an increase in the risk of any coronary event (2,091 events; hazard ratio [HR], 1.04; 95% confidence interval [CI], 1.01-1.07; p = 0.01). Increased risk was also observed for any CV event (2,727 events; HR, 1.04; 95% CI, 1.02-1.07; p < 0.001), and for death (487 events; HR, 1.09; 95% CI, 1.07-1.12; p < 0.001). Among patients in the quintile with the highest variation in body weight, the risk of a coronary event was 64% higher, the risk of a CV event was 85% higher, death was 124% higher, MI was 117% higher, and stroke was 136% higher than it was among those in the quintile with the lowest variation in body weight in adjusted models.

Conclusions:

The authors concluded that among participants with CAD, fluctuation in body weight was associated with higher mortality and a higher rate of CV events independent of traditional CV risk factors.

Perspective:

Prior studies have observed increased risk for CV disease with fluctuations in weight among healthy adults. These data suggest that there is also a risk among adults with prior CAD. Healthcare providers may want to focus on healthy behaviors such as regular physical activity and a healthy diet, as opposed to a patient’s weight.

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Diabetes and Cardiometabolic Disease, Dyslipidemia, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Vascular Medicine, Implantable Devices, SCD/Ventricular Arrhythmias, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Cardiac Surgery and SIHD, Lipid Metabolism, Acute Heart Failure, Interventions and Coronary Artery Disease, Interventions and Vascular Medicine, Exercise, Smoking

Keywords: Angina Pectoris, Body Weight, Coronary Artery Disease, Diabetes Mellitus, Exercise, Heart Arrest, Heart Failure, Lipids, Myocardial Infarction, Myocardial Revascularization, Peripheral Vascular Diseases, Primary Prevention, Renal Insufficiency, Chronic, Risk Factors, Smoking, Stroke


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