Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Fluctuation of Body Weight & Coronary Events

N Engl J Med; 2017 Apr 6; Bangalore, et al

Fluctuation in body weight among patients with coronary artery disease (CAD) is associated with higher mortality and a higher rate of cardiovascular (CV) events, a recent study found, and independent of traditional CV risk factors. Intra-individual fluctuations in body weight from baseline weight and follow-up visits were determined and a post hoc analysis of the Treating to New Targets trial, which assessed the efficacy and safety of lowering low-density lipoprotein cholesterol levels with atorvastatin, performed. Primary outcome of the study was any coronary event. Researchers found:

  • Among 9,509 participants and after adjustment for risk factors, each increase of 1 SD in body-weight variability was associated with an increase in the risk of any coronary events.
  • Among patients in the quintile with the highest variation in body weight, the risk of a coronary event was 64% higher; CV event 85% higher, death 124% higher, myocardial infarction 117% higher, and stroke 136% higher, compared to those in the quintile with the lowest variation in body weight.


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;376:1332-40. doi:10.1056/NEJMoa1606148.


It is clear that obesity increases the risk of cardiovascular disease.1 It is also clear that in the general population, weight loss is associated with improved outcomes and decreased risk of diabetes and hypertension. When we recommend weight loss to patients, they often lose weight and then regain it, a pattern aptly named the “yo-yo” effect. And, in the general population, the effect of weight variability over time is not clear. This study enrolled only people with established coronary disease and had 12 weight measurements over 5 years. Among patients who were overweight or obese, high body weight variability over time led to a greater risk of coronary events than occurred in those with stable weight. This presents an important clinical dilemma: is it better to attempt weight loss even with a risk of weight regain, or to accept someone’s current weight and the risk that goes along with maintaining that weight, but not potentially increasing the risk by recurrent weight loss and weight gain? —Neil Skolnik, MD

  1. Wilson PW, D’Agostino RB, Sullivan L, Parise H, Kannel WB. Overweight and obesity as determinants of cardiovascular risk: the Framingham experience. Arch Intern Med. 2002;162:1867-72.