Prognostic implications of weight gain and weight loss in adults with congenital heart disease
Section snippets
Clinical summary
In this study we assessed the relationship between temporal change in body mass index (BMI) and clinical outcomes in adults with congenital heart disease (CHD). We observed a net weight gain resulting in a significant increase in the prevalence of overweight and obesity within a relatively short period. Weight gain was associated with worsening atherosclerotic cardiovascular disease (ASCVD) risk profile and higher risk of cardiovascular events. Conversely, weight loss occurred in a minority of
Study population
This is a retrospective cohort study of adults (age > 18 years) with CHD that received care at Mayo Clinic Rochester, MN, and had 5 or more years of clinical follow-up, from January 1, 2003 to December 31, 2019. The CHD diagnoses were classified as severe CHD versus non-severe CHD based on the classification scheme proposed by Marelli et al. [16]
The first clinical evaluation in the CHD clinic within the study period was considered as the ‘baseline assessment’, and the clinical evaluation
Baseline characteristics
We identified 3542 patients with 5 or more years of clinical follow-up. Of these 3542, we excluded 135 (4%) that were underweight at baseline, and the remaining 3407 patients were included this study. These 3407 patients were categorized into the following groups: normal weight (n = 1330, 39%), overweight (n = 1157, 34%), obesity (n = 791, 23%), and morbid obesity (n = 129, 4%). Table 1 shows a comparison of the baseline characteristics of the different groups. Compared to the patients with
Discussion
In this study, we assessed temporal change in BMI, and its relationship to clinical outcomes. The main findings are: (1) There was a net weight gain over time resulting in an increase in the prevalence of overweight and obesity; (2) Weight gain was associated with worsening ASCVD risk profile (increase in severity of hypertension, hyperlipidemia, and T2DM) especially in patients that were already overweight or obese at baseline; (3) Weight gain was associated with cardiovascular events in
Study limitations
This is a retrospective single center study, and hence it is prone to selection and ascertainment bias which may impede the generalizability of the results. We do not have complete data about all heart failure related events, and lifestyle interventions for all patients in the cohort. Additionally, we could not verify compliances with medical therapy which could have influenced the observed temporal changes in ASCVD risk profile in this study.
Conclusions
The current study showed a net weight gain resulting in a significant increase in the prevalence of overweight and obesity within a relatively short period, and weight gain was associated with worsening ASCVD risk profile and higher risk of cardiovascular events. Conversely, weight loss occurred in a minority of the cohort (9%) and was associated with improvement in ASCVD risk profile and reduction in the risk of cardiovascular events. Collectively, the results provide empirical evidence to
Funding
Dr. Egbe is supported by National Heart, Lung, and Blood Institute (NHLBI) grants (K23 HL141448, R01 HL158517 and R01HL160761). The MACHD Registry is supported by the Al-Bahar Research grant.
Disclosures
None.
Declaration of Competing Interest
None.
Acknowledgement
None.
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