Potential long-term benefits of purposeful weight loss in overweight and obese patients with coronary heart disease
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Although obesity is a cardiovascular risk factor, it may be associated with a more favourable prognosis in cardiac patient cohorts. Whether weight loss counteracts the cardiovascular benefit afforded by this “obesity paradox” is not established. This was retrospectively investigated in 529 consecutive patients participating in a cardiac rehabilitation and exercise training (CRET) programme following major coronary events. Three-year total mortality was compared in various body mass index (BMI) categories. After CRET, overweight and obese patients with greater weight loss exhibited significant improvements in peak oxygen consumption, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, C-reactive protein, and fasting glucose, as well as marked improvements in behavioural factors and quality-of-life scores. In contrast, those with lower weight loss showed no significant improvements in most of these parameters. During the 3-year follow-up, overall mortality tended to be slightly lower in patients with baseline overweight/obesity who lost more weight. However, total mortality was considerably lower in patients with baseline overweight/obesity as compared to those with baseline normal BMI, as well as in patients with high baseline body fat as compared to those with low baseline body fat. Thus, although an obesity paradox does exist when considering either baseline BMI or baseline percent fat criteria, the study findings support the potential long-term benefits of purposeful weight loss in overweight and obese patients with coronary heart disease.
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