TY - JOUR
T1 - The prognostic importance of weight loss in coronary artery disease
T2 - A systematic review and meta-analysis
AU - Pack, Quinn R.
AU - Rodriguez-Escudero, Juan Pablo
AU - Thomas, Randal J.
AU - Ades, Philip A.
AU - West, Colin P.
AU - Somers, Virend K.
AU - Lopez-Jimenez, Francisco
N1 - Funding Information:
Grant Support: This meta-analysis was supported in part by Clinical and Translational Science Award grant TL1 TR000137 from the National Center for Advancing Translational Science .
Publisher Copyright:
© 2014 Mayo Foundation for Medical Education and Research.
PY - 2014/10/1
Y1 - 2014/10/1
N2 - Objective: To assess the prognostic impact of weight loss on clinical outcomes in patients with coronary artery disease (CAD).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 followup) 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).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.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.
AB - Objective: To assess the prognostic impact of weight loss on clinical outcomes in patients with coronary artery disease (CAD).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 followup) 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).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.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.
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U2 - 10.1016/j.mayocp.2014.04.033
DO - 10.1016/j.mayocp.2014.04.033
M3 - Article
C2 - 25199859
AN - SCOPUS:84908105754
SN - 0025-6196
VL - 89
SP - 1368
EP - 1377
JO - Mayo Clinic Proceedings
JF - Mayo Clinic Proceedings
IS - 10
ER -