Weight-change as a prognostic marker in 12 550 patients following acute myocardial infarction or with stable coronary artery disease.
OBJECTIVE
To examine the prognostic importance of weight-change in patients with coronary artery disease (CAD), especially following acute myocardial infarction (AMI).


RESULTS
In 4360 AMI patients (OPTIMAAL trial) without baseline oedema, we assessed 3-month weight-change, baseline body mass index (BMI), demographics, patient history, medication, physical examination, and biochemical analyses. Weight-change was defined as change >+/-0.1 kg/baseline BMI-unit. Patients were accordingly categorized into three groups; weight-loss, weight-stability, and weight-gain. Our findings were validated in 4012 AMI patients (CONSENSUS II trial) and 4178 stable CAD patients (79% with prior AMI, 4S trial). Median follow-up was 2.7 years, 3 months, and 4.4 years, respectively. In OPTIMAAL, 3-month weight-loss (vs. weight-stability) independently predicted increased all-cause death [n=471; hazard ratio (HR) 1.26; 95% CI 1.01-1.56; P=0.039] and cardiac death (n=299, HR 1.33, 95% CI 1.02-1.73, P=0.034). Weight-gain yielded risk similar to weight-stability (HR 1.07, P=0.592 and 0.97, P=0.866, respectively). In CONSENSUS II, 3-month weight-loss independently predicted increased mortality (HR 3.87, P=0.008). Weight-gain yielded risk similar to weight-stability (HR 1.11, P=0.860). In 4S, 1-year weight-loss independently predicted increased mortality (HR 1.44, P=0.004). Weight-gain conferred risk similar to weight-stability (HR 1.05, P=0.735).


CONCLUSIONS
In patients following AMI or with stable CAD, weight-loss but not weight-gain was independently associated with increased mortality risk.
Kennedy
Linn M A
LM
Department of Cardiology, Malmö University Hospital, Lund University, S-205 02 Malmö, Sweden. linn.kennedy@med.lu.se
Dickstein
Kenneth
K
Anker
Stefan D
SD
James
Margaret
M
Cook
Thomas J
TJ
Kristianson
Krister
K
Willenheimer
Ronnie
R
D000368:Aged; D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology*; D002423:Cause of Death; D032921:Consensus; D003324:Coronary Artery Disease / Q000401:mortality* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality* / Q000503:physiopathology; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors