Prognostic implications of weight gain and weight loss in adults with congenital heart disease

Background: There are conflicting data about the association between obesity and clinical outcomes in adults with congenital heart disease (CHD), and the effects of weight gain or weight loss remain unclear. The purpose of this study was to determine whether a temporal change in body mass index (BMI) was associated with clinical outcomes independent of baseline BMI in adults with CHD.

Methods: Retrospective cohort study of adults with CHD that had clinical assessments at baseline and 5 years afterwards. Weight gain and weight loss were defined as ≥5% change from baseline BMI. Atherosclerotic cardiovascular disease (ASCVD) risk profile (blood pressure [BP], low density lipoprotein cholesterol [LDL-C] and hemoglobin A1C [HBA1c]) and cardiovascular events (heart failure hospitalization, transplant, death) were ascertained.

Results: Of the 3407, 1804 (53%) had stable weight, 1291 (38%) had weight gain, and 312 (9%) had weight loss at follow-up assessment. The median change in BMI (∆ BMI) was +3% (1-5). The baseline BMI and ∆ BMI were associated with worsening ASCVD risk profile (higher BP, LDL-C and HBA1C), and an increase in cardiovascular events in patients with obesity at baseline.

Conclusions: Collectively, the results provide evidence to support lifestyle interventions aimed at weight maintenance in patients with normal weight, and to promote weight loss in patients that are overweight or obese. Further studies are required to determine the optimal type of lifestyle interventions that will be most effective in this population.