Cardiovascular Disease Risk Increases With Body Weight Fluctuations

Fluctuations in body weight may be independently associated with increased risks for mortality and cardiovascular events, according to a study published in the New England Journal of Medicine.¹

Obesity and weight gain increase the risk for cardiovascular disease and mortality, and weight loss lowers this risk.^2,3 However, many patients who successfully lose weight end up regaining weight, and may continue to lose and gain weight in a pattern known as “weight cycling.” Whether body weight fluctuations lead to worse clinical outcomes has been unclear, since data on this topic are limited and conflicting.

Sripal Bangalore, MD, from the New York University School of Medicine in New York City and colleagues investigated the effect of body weight fluctuations on cardiovascular events and death in a post hoc analysis of the Treating to New Targets (TNT; ClinicalTrials.gov identifier: NCT00327691) trial.

The primary outcome was any coronary event, defined as a composite of nonfatal myocardial infarction (MI), angina, revascularization, resuscitated cardiac arrest, and death from coronary artery disease. Secondary outcomes included MI, stroke, death, new-onset diabetes, and any cardiovascular event (defined as a composite of heart failure, peripheral vascular disease, any coronary event, or any cerebrovascular event).

Data from 9509 patients were included for analysis. Mean baseline body weight was 85 kg, and 1 standard deviation (SD) of body weight variability ranged from 1.5 kg to 1.9 kg.

Increases in body weight variability were associated with higher rates of any coronary event (hazard ratio [HR], 1.04 per 1-SD increase; 95% CI, 1.01-1.07; P =.01), death (HR, 1.09 per 1-SD increase; 95% CI, 1.07-1.12; P <.001), and any cardiovascular event (HR, 1.04 per 1-SD increase; 95% CI, 1.02-1.07; P <.001). Stroke and MI risks were also higher with increases in body weight variability, but these trends did not reach statistical significance.

Compared with patients in the quintile with the lowest variation of body weight, patients in the quintile with the highest variation had greater risk of experiencing coronary events, cardiovascular events, MI, stroke, new-onset diabetes, and death. The degree of increased risk ranged from 64% to 136%.

“The study shows that weight fluctuations are associated with worse cardiovascular outcomes and also increase the risk of diabetes. These findings can potentially be used to counsel patients to try to maintain their weight after weight loss,” Dr Bangalore told Cardiology Advisor.

“The mechanism by which weight fluctuations impact cardiovascular events is not fully known at this point, but there are a few theories, including potential stress due to change in body volume and neurohumoral changes,” he added.

Disclosures: This study was funded by Pfizer. 

References

1. Bangalore S, Fayyad R, Laskey R, DeMicco DA, Messerli FH, Waters DD. Body-weight fluctuations and outcomes in coronary disease. N Engl J Med. 2017;376(14):1332-1340. doi:10.1056/NEJMoa1606148
2. Rosengren A, Wedel H, Wilhelmsen L. Body weight and weight gain during adult life in men in relation to coronary heart disease and mortality: a prospective population study. Eur Heart J. 1999;20:269-277.
3. Yarnell JW, Patterson CC, Thomas HF, Sweetnam PM. Comparison of weight in middle age, weight at 18 years, and weight change between, in predicting subsequent 14 year mortality and coronary events: Caerphilly Prospective Study. J Epidemiol Community Health. 2000;54:344-348.