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03-18-2022 | Cardiovascular outcomes | News

Weight gain and loss may both signal high cardiovascular risk in type 2 diabetes

Author: Eleanor McDermid

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medwireNews: The gain or loss of more than 5% bodyweight within a 2-year period is associated with an increased risk for major adverse cardiovascular events in people with type 2 diabetes, say researchers.

Hyung-Kwan Kim (Seoul National University Hospital, Republic of Korea) and colleagues used the Korean National Health Insurance Service database to identify 1,522,241 people (average age 56.3 years, 63.7% men) who had type 2 diabetes and no history of major cardiovascular disease events.

The majority of study participants lost or gained no more than 5% of their starting bodyweight over a 2-year period between two health check-ups. But 8% gained 5–10% and 2% gained more than that, and 12% and 3% lost the corresponding amounts of weight. Baseline BMIs in these groups ranged from 22.7 kg/m2 in the group with the most weight loss to 26.2 kg/m2 in the group with the most weight gain.

As reported in Diabetes Care, the team found a U-shaped relationship between these previous bodyweight changes and cardiovascular outcomes during a median follow-up of 7 years.

The strongest associations were seen for heart failure risk, with adjusted incidence rates of 10.73, 7.95, 6.44, 7.00, and 8.77 per 1000 person–years for people who, respectively, lost more than 10% bodyweight, lost 5–10%, remained relatively stable, gained 5–10%, and gained more than 10%.

After accounting for confounders, the risk for heart failure was significantly increased for people with weight loss or gain of at least 5% relative to those with stable weight, with hazard ratios ranging from 1.13 to 1.41.

This pattern was also observed for myocardial infarction, ischemic stroke, and atrial fibrillation, with almost all associations being statistically significant.

Furthermore, the same pattern was present for all-cause mortality, with adjusted incidence rates of 19.04, 10.80, 7.35, 8.62, and 12.09 per 1000 person–years across the groups from more than 10% weight loss to more than 10% weight gain. The adjusted hazard ratios for mortality relative to people in the stable weight group ranged from 1.23 to 1.87.

The researchers speculate that weight loss could lead to frailty and an increased risk for hypoglycemic events via the reduction of lean mass, and note that bodyweight variability per se has been linked to an increased risk for cardiovascular events.

“Taken together, the longer-term association between weight loss and cardiovascular events in patients with [type 2 diabetes] is possibly more complicated than we have expected based only on simple metabolic profile improvement with relatively limited follow-up duration,” they write.

The study authors add that they could not distinguish between intentional and unintentional weight loss, the latter of which could relate to an underlying disease condition.

“Therefore, weight loss in patients with [type 2 diabetes] observed in the clinic might not necessarily reflect metabolic improvement,” says the team.

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2022 Springer Healthcare Ltd, part of the Springer Nature Group

Diabetes Care 2022; doi:10.2337/dc21-2299


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