Elsevier

International Journal of Cardiology

Volume 371, 15 January 2023, Pages 147-152
International Journal of Cardiology

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

https://doi.org/10.1016/j.ijcard.2022.09.032Get rights and content

Highlights

  • Of the 3,407, 1,804 (53%) had stable weight, 1,291 (38%) had weight gain, and 312 (9%) had weight loss.

  • The baseline BMI and ∆ BMI were associated with worsening ASCVD risk profile and cardiovascular events.

  • Weight loss was associated with improvement in ASCVD risk profile and reduction in cardiovascular events.

Abstract

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.

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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