Prevention program results in weight loss in patients with CAD
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A comprehensive secondary prevention program achieved significantly increased weight-loss rates in patients with CAD who were overweight, researchers reported in Heart.
Previously, researchers evaluated this weight-loss program as a comprehensive secondary prevention strategy in the multicenter randomized RESPONSE-2 trial and found that a combination of nurse-coordinated care and referral to up to three community-based lifestyle programs, in addition to usual care, was significantly more effective in improving at least one lifestyle-related risk factor compared with only usual care.
“The lifestyle programs addressed weight reduction, promoting physical activity and smoking cessation, and referral was dependent on the patients’ risk profile and preferences,” Arno Tijssen, clinical epidemiologist and remedial therapist at the Centre of Expertise and the Faculty of Health at Amsterdam University of Applied Sciences, and colleagues wrote. “The difference in the primary outcome was mainly driven by improvements in weight reduction.”
This secondary analysis used data on a subgroup of patients with CAD who were overweight with a BMI of at least 27 kg/m2 from the RESPONSE-2 trial. Patients were randomly assigned to the intervention plus the usual care (n = 280) or the usual care alone (n = 257). Researchers assessed change in weight from baseline to 12 months during follow-up.
There was significantly more weight loss observed among patients in the intervention group compared with controls, with an average of –2.4 kg lost vs. –0.2 kg (P < .001). There was a wide variation in individual weight change, ranging from 23 kg gained to –25 kg lost in the intervention group compared with 13 kg gained and –15 kg lost in the control group. Weight gain of at least 1 kg was observed among 36% of patients in the intervention group and 41% of controls (P = .021).
Researchers observed weight loss of at least 5% was associated with older age (OR = 2.94; 95% CI, 1.57-5.48; P < .001), lower educational level (OR = 1.91; 95% CI, 1.05-3.5; P = .04), nonsmoking status (OR = 2.92; 95% CI, 1.56-5.46; P < .001), weight-loss motivation directly after baseline (OR = 2.31; 95% CI, 0.88-6.02; P = .09) and participation in the weight-loss program (OR = 3.33; 95% CI, 1.6-6.99; P = .002) among patients in the intervention group. In addition, among these patients, weight gain of at least 1 kg was associated with smoking cessation 6 months or less before or during hospitalization (OR = 3.21; 95% CI, 1.7-6.08; P < .001), non-Caucasian ethnicity (OR = 2.77; 95% CI, 0.9-8.55; P = .08), smoking at baseline (OR = 2.7; 95% CI, 1.38-5.27; P = .004), being younger than 65 years (OR = 1.47; 95% CI, 0.78-2.78; P = .23) and participation in the weight-loss program (OR = 0.59; 95% CI, 0.34-1.02; P = .06).
“Alarmingly, weight gain was highly prevalent, and prevention of weight gain may be as important as attempts at weight loss,” the researchers wrote. “The identified determinants of weight change may contribute to further development of effective weight management strategies.”
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