Weight Change and Long-term Cardiovascular Outcomes in Overweight and Obese Patients after Acute Coronary Syndromes

Abstract Aims Overweight and obesity are common among patients with acute coronary syndromes (ACS), yet the long-term cardiovascular consequences of post-ACS weight change remain uncertain. We investigated the association between 1-year weight change after ACS and 5-year clinical outcomes in overweight and obese patients. Methods We analyzed 1,473 overweight and obese ACS participants from the Swiss ELIPS cohort with available weight measurements. Hazard ratios (HRs) were estimated per 1% and 5% weight change for the 5-year risk of major adverse cardiovascular events (MACE), defined as cardiovascular death, non-fatal myocardial infarction, coronary revascularization, stroke, or transient ischemic attack. Models were adjusted for age, sex, BMI, smoking, total cholesterol, hypertension, diabetes, and eGFR. Predefined subgroups included BMI ≥27 kg/m2 versus 25–27 kg/m2. Results Among the participants (15.1% women, mean age 61.5 years), the median BMI was 28.1 kg/m2 (67% BMI ≥27 kg/m2). Median 1-year weight change was 0%; 47.5% lost weight and 18.7% achieved >5% weight loss. Patient characteristics associated with weight loss were older age, higher BMI, non-smoking status, and participation in cardiac rehabilitation. During follow-up, 278 MACE events occurred. Weight loss was associated with a lower risk of MACE (multivariate-adjusted HR per 5%: 0.90, 95% CI: 0.82–1.00, p=0.04). The association was stronger in patients with BMI ≥ 27 kg/m2 (adj HR per 5% 0.87, 95% CI: 0.77-0.97) compared to those with BMI 25-27 kg/m2 (adj HR per 5% 1.01, 95% CI: 0.85-1.20, interaction p = 0.16). Conclusion Overweight and obese ACS patients who lose weight may have a lower risk of cardiovascular events.