Weight loss in patients with coronary heart disease is neglected! A study in 29 European countries

A study of more than 10,000 patients with coronary heart disease published in a subsidiary of the European Heart Journal showed that weight management has become a "blind spot" in clinical management.

The study found that when these patients were hospitalized for cardiovascular events, less than 20% of them remained within the normal weight range.

In the following 16 months, 86% of patients who were obese at the time of admission remained obese, and 14% of overweight patients became obese. Young women were particularly troubled by their weight, with nearly half of those under 55 years old being obese.

Regrettably, more than one-third of obese patients said that they did not receive any advice on physical activity or nutrition; about one-fifth of patients said that no one told them that their weight was overweight.

"It seems that no doctors consider obesity to be a serious problem. This blind spot needs attention and patients need to be advised of clear personal weight control goals," the researchers said.

In fact, for overweight or obese patients with coronary heart disease, weight loss can help improve blood pressure, blood lipids and reduce the risk of type 2 diabetes to reduce cardiovascular events, which is strongly recommended by the guidelines.

The study also found that patients who were overweight or obese when hospitalized for cardiovascular events had significantly lower blood pressure, blood lipids and the proportion of previously undiagnosed diabetes after losing at least 5% of their weight, compared with patients who gained at least 5% of their weight, even though they took the same antihypertensive and lipid-lowering drugs.

In addition to the positive changes in the "three highs", patients who have lost weight have more physical strength and a better mental outlook.

The study also showed that for overweight or obese patients, improved lifestyle has a positive impact on weight loss. Compared with patients who gained at least 5% of their weight, those who lost at least 5% of their weight had a significantly reduced frequency of oil and sugar intake, ate fruits, vegetables and fish significantly more frequently, exercised more regularly, participated in more cardiac rehabilitation and prevention programs, and followed relevant dietary recommendations.

The researchers also noted that weight gain was significantly associated with smoking cessation, with patients gaining an average of 1.8 kg in weight after quitting, while those who did not quit gained 0.4 kg.

However, many studies have shown that gaining weight after quitting smoking is not in vain.

A Korean study that tracked more than 100,000 men for eight years showed that even if they had a fat waist and a big belly and the three highs after quitting smoking, their risk of myocardial infarction was reduced by 67% and their risk of stroke was reduced by 25% compared with those who did not quit smoking.

Moreover, for East Asians, relevant studies show that smokers who quit smoking will gain about 2 kg in about half a year, while Europeans and Americans will become even fatter.

This study pooled data from the EUROASPIRE IV (2012-2013) and EUROASPIRE V (2016-2017) trials, which included 10,507 patients with coronary heart disease from 29 countries and regions, 24.8% of whom were women, with an average age of 62.5 years for cardiovascular hospitalization. Patients were followed up 6 to 24 months after hospitalization for cardiovascular events (average interval of 16 months).

When patients were hospitalized for the first or recurrent cardiovascular event, 34.9% were obese and 46% were overweight. Of the patients who were advised to lose weight, half were advised to follow a cardiac prevention and rehabilitation program; less than two-thirds of obese patients were advised to follow dietary guidelines or exercise regularly.

Obesity is defined as a body mass index (the ratio of weight to the square of height) ≥ 30, and overweight is defined as a body mass index between 25 and 30.

Source: China Circulation Magazine