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The Prognostic Importance of Weight Loss in Coronary Artery Disease: A Systematic Review and Meta-analysis

Published:September 06, 2014DOI:https://doi.org/10.1016/j.mayocp.2014.04.033

      Abstract

      Objective

      To assess the prognostic impact of weight loss on clinical outcomes in patients with coronary artery disease (CAD).

      Methods

      We performed a systematic review and meta-analysis of the prognostic effects of weight loss in patients with CAD on a composite outcome of all-cause mortality, cardiovascular mortality, and major adverse cardiac events considering studies published between January 1, 1964, and August 8, 2013. We considered weight loss “intentional” when it occurred in the presence of programmed therapeutic lifestyle changes and “observational” when no such intervention was specified.

      Results

      We searched 1218 abstracts, of which 12 studies with 14 cohorts met the inclusion criteria. A total of 35,335 patients (mean age, 64 years; 72% male; body mass index [BMI], 30; 3.2 years of follow-up) were included. Overall, weight loss was associated with a greater risk of the composite outcome (relative risk [RR], 1.30; 95% CI, 1.00-1.69; P=.05). However, heterogeneity was high (I2=90%) and was substantially explained by weight loss intentionality. Presumed intentional weight loss (4 cohorts) was associated with improved outcomes (RR, 0.67; 95% CI, 0.56-0.80; P<.001), whereas observational weight loss (10 cohorts) was associated with worsened outcomes (RR, 1.62; 95% CI, 1.26-2.08; P<.001; interaction P<.001).

      Conclusion

      Whereas observational weight loss is associated with increased adverse cardiovascular events, intentional weight loss is associated with lower clinical events. These results suggest that the underlying mechanism of weight loss (ie, intentional or unintentional) affects its impact on subsequent risk in persons with known CAD.

      Abbreviations and Acronyms:

      4S (Scandinavian Simvastatin Survival Study), aHR (adjusted hazard ratio), AMI (acute myocardial infarction), BMI (body mass index), CABG (coronary artery bypass graft), CAD (coronary artery disease), CBT (cognitive behavioral therapy), CONSENSUS (Cooperative North Scandinavian Enalapril Survival Study), CV (cardiovascular), DM (diabetes mellitus), F/u (follow-up), HF (heart failure), HR (hazard ratio), IV (inverse variance), Look AHEAD (Action for Health Diabetes), MACE (major adverse cardiac event), M-H (Mantel-Haenszel), NR (not recorded), OPTIMAAL (Optimal Trial in Myocardial Infarction With the Angiotensin II Antagonist Losartan), PCI (percutaneous coronary intervention), PROactive (Prospective Pioglitazone Clinical Trial in Macrovascular Events), RCT (randomized controlled trial), RR (relative risk), SCOUT (Sibutramine Cardiovascular Outcomes), TLC (therapeutic lifestyle change), VA-HIT (Veterans Affairs High-Density Lipoprotein Intervention Trial), Wt. Δ def. (weight change definition), Wt. Δ time (weight change interval time)
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