Conference Coverage

Study hints at obesity paradox in older women with coronary artery disease



AMSTERDAM – Older women with coronary artery disease who lost weight had an increased risk of death regardless of their body mass index, a finding that hints at the presence of an obesity paradox in this population, according to a registry-based retrospective study.

The unpublished abstract, which was presented at the annual congress of the European Society of Cardiology, also showed that, among patients who maintained their weight, underweight women had a twofold increase in risk of all-cause mortality while obese and overweight women had a nonsignificant but reduced risk of death, compared with normal-weight patients.

Although studies have shown that obesity is a risk factor for developing cardiovascular disease, and guidelines recommend weight loss for patients who are overweight and obese, the study’s key message is that advising weight loss to patients with heart disease is not so simple and straightforward, said Dr. Diethelm Tschoepe of Ruhr University in Bochum, Germany, who commented on the study.

Researchers analyzed data for 1,685 women with an average age of 64 years who were diagnosed with coronary artery disease (CAD) based on angiography between 2005 and 2011.

They stratified the cohort into three weight-change groups: no change (gain or loss of less than 2 kg/year), weight loss (loss of more than 2 kg/year), and weight gain (gain of more than 2 kg/year.)

Each group was then divided into four weight classes based on body mass index: underweight (BMI less than 20 kg/m2), normal weight (BMI 20-24.9 kg/m2), overweight (BMI 25-29.9 kg/m2), and obese (BMI more than 30 kg/m2).

The normal-weight group was used as reference to calculate the hazard ratios. Data were adjusted for age, smoking, diabetes, previous heart surgery, use of statins and antihypertensive drugs, degree of CAD, and previous percutaneous coronary intervention.

When comparing the BMI in weight-change groups, women who were underweight and maintained their weight had a twofold increase in death (hazard ratio, 2.15; P = .03), compared with normal-weight women. Also, when these women lost weight, their risk was increased by almost twofold, although it didn’t reach statistical significance.

Among the different BMI groups, obese women who lost weight had an eightfold increase in the risk of all-cause mortality, and obese women who gained weight had a more than fourfold risk increase, compared with obese women who maintained their weight.

Meanwhile, overweight and normal-weight women who lost weight had sixfold and threefold increases in risk of death, respectively, compared with their stable-weight counterparts.

Dr. Aziza Azimi of Gentofte Hospital, Copenhagen, who presented the study, said that the findings highlight the importance of individual-based weight management.

Researchers said that, since the study subjects had comorbidities, their weight management should be handled differently from the general population. They added that, because of the retrospective design of the study, it’s not clear why the women lost weight, although, given their condition, it was most probably unintentional and due to comorbidities or medications.

Dr. Azimi and Dr. Tschoepe had no disclosures.

On Twitter @NaseemSMiller

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