Heartbeat: weight loss interventions in patients with cardiovascular disease

Abstract

Overweight and obesity are major risk factors for cardiovascular disease (CVD) and meaningful weight loss is associated with a reduction in CVD risk. Yet patients’ efforts at weight reduction often are frustratingly futile. In this issue of Heart, Tijssen and colleagues evaluated weight change from baseline to 12month followup in the subgroup of overweight patients (BMI ≥27 kg/m) with coronary artery disease in the Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists-2 (RESPONSE-2) multicentre randomised trial. The 280 patients in the intervention arm were offered communitybased programmes to achieve weight reduction, increase physical activity and stop smoking in addition usual care, which included cardiology visits, cardiac rehabilitation and counselling on secondary prevention. Although there was wide variation in weight loss for patients in both the intervention and usual care groups, participation in a weight loss programme was associated with weight loss of ≥5% (OR 3.33 compared with usual care) (figure 1). Other factors associated with meaningful weight loss were older age, lower educational level, not smoking and motivation to start weight loss at the baseline visit. This data supports the wider use of communitybased weight loss programmes as a feasible and low cost approach to meaningful weight reduction in our patients with CVD. However, as Kelsey and Pagidipati comment in an editorial “Beyond behavioural and psychosocial characteristics, molecular and genetic factors also play a role in response to weight loss interventions” (figure 2). They argue that “Development of a personalised approach can and should match patient to treatment to obtain maximally effective and durable weight loss results.” Both coronary artery (CAC) and aortic valve calcification (AVC) are associated with an increased risk of CVD events but it remains unclear whether this simply reflects shared clinical risk factors or whether AVC scores provide additive predictive value, independent of CAC score, for CVD events. In a study of 14 073 men aged 60 to 74 years of age in the DANish CArdioVAscular Screening and intervention trial (DANCAVAS), AVC was present in 58% with 1.5% having an AVC score ≥1200 (suggestive of severe aortic stenosis). After accounting for CAC scores, the only CVD risk factors independently associated with AVC were older age, hypertension, obesity, known CVD and serum phosphate levels.