European Heart Journal Advance Access originally published online on August 4, 2006
European Heart Journal 2006 27(23):2755-2762; doi:10.1093/eurheartj/ehl182
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Weight-change as a prognostic marker in 12 550 patients following acute myocardial infarction or with stable coronary artery disease
1 Department of Cardiology, Malmö University Hospital, Lund University, S-205 02 Malmö, Sweden
2 Cardiology Division, Stavanger University Hospital, University of Bergen, Norway
3 Division of Applied Cachexia Research, Department of Cardiology, Charité Campus Virchow Klinikum, Berlin, Germany
4 Merck & Co., Whitehouse Station, NJ, USA
5 Department of Clinical Pharmacology, Institution for Laboratory Medicine, Karolinska University Hospital, Huddinge, Sweden
Received 8 September 2005; revised 8 June 2006; accepted 14 July 2006; online publish-ahead-of-print 4 August 2006.
* *Corresponding author. Tel: +46 40 331000; fax: +46 40 336209. E-mail address: linn.kennedy{at}med.lu.se
Aims To examine the prognostic importance of weight-change in patients with coronary artery disease (CAD), especially following acute myocardial infarction (AMI).
Methods and results In 4360 AMI patients (OPTIMAAL trial) without baseline oedema, we assessed 3-month weight-change, baseline body mass index (BMI), demographics, patient history, medication, physical examination, and biochemical analyses. Weight-change was defined as change >±0.1 kg/baseline BMI-unit. Patients were accordingly categorized into three groups; weight-loss, weight-stability, and weight-gain. Our findings were validated in 4012 AMI patients (CONSENSUS II trial) and 4178 stable CAD patients (79% with prior AMI, 4S trial). Median follow-up was 2.7 years, 3 months, and 4.4 years, respectively. In OPTIMAAL, 3-month weight-loss (vs. weight-stability) independently predicted increased all-cause death [n=471; hazard ratio (HR) 1.26; 95% CI 1.01–1.56; P=0.039] and cardiac death (n=299, HR 1.33, 95% CI 1.02–1.73, P=0.034). Weight-gain yielded risk similar to weight-stability (HR 1.07, P=0.592 and 0.97, P=0.866, respectively). In CONSENSUS II, 3-month weight-loss independently predicted increased mortality (HR 3.87, P=0.008). Weight-gain yielded risk similar to weight-stability (HR 1.11, P=0.860). In 4S, 1-year weight-loss independently predicted increased mortality (HR 1.44, P=0.004). Weight-gain conferred risk similar to weight-stability (HR 1.05, P=0.735).
Conclusion In patients following AMI or with stable CAD, weight-loss but not weight-gain was independently associated with increased mortality risk.
Key Words: Coronary artery disease • Acute myocardial infarction • Weight-change • Prognosis • Mortality