Weight change and risk of cardiovascular disease among adults with type 2 diabetes: more than 14 years of follow-up in the Tehran Lipid and Glucose Study

Abstract

Background To examine the impact of weight change on incident cardiovascular disease and coronary heart disease (CVD/CHD) among an Iranian population with type 2 diabetes mellitus (T2DM). Methods The study population included 763 participants with T2DM aged ≥ 30 years without a history of CVD and cancer at baseline. Two weight measurements done at baseline and about 3 years later. Based on their weight change, they categorized into: > 5% loss, 3–5% loss, stable (± < 3%), 3–5% gain, > 5% gain. Participants were then followed for incident CVD/CHD annually up to 20 March 2018. Multivariable Cox proportional hazard models, adjusted for age, sex, body mass index, educational level, current smoking, glucose-lowering drug use, family history of CVD, hypertension, hypercholesterolemia, chronic kidney disease, and fasting plasma glucose (FPG) were applied to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of weight change categories for incident CVD/CHD, considering stable weight as reference. Results After the weight change measurement, during a median follow-up of 14.4 years, 258 CVD and 214 CHD occurred. Over 5% weight gain was associated with reduced risks of CVD and CHD development by the HRs of 0.70 [95% CI 0.48–1.01; P-value: 0.058] and 0.61 [0.40–0.93], respectively, in multivariable analysis. After further adjustment for FPG change, the HRs of weight gain > 5% were attenuated to 0.75 [0.51–1.10; P-value: 0.138] and 0.66 [043–1.01; P-value: 0.053] for incident CVD and CHD, respectively. The effect of weight loss > 5% was in opposite direction among those older versus younger than 60 years; with suggestive increased risk (not statistically significant) of incident CHD/CVD for the older group. Moreover, weight gain > 5% significantly reduced the risk of CHD only among those older than 60 years (P-value for interaction < 0.2). Furthermore, weight gain > 5% had an association with lower risk of CVD and CHD among sulfonylurea users (0.56 [0.32–0.98] for CVD and 0.54 [0.29–0.99] for CHD). Conclusions Our results with a long-term follow-up showed that weight gain > 5% was associated with better CVD/CHD outcomes among Iranian participants with T2DM, especially older ones. Moreover, we did not find an unfavorable impact on incident CVD/CHD for sulfonylurea-induced weight gain.

Body weight changes in patients with type 2 diabetes and a recent acute coronary syndrome: an analysis from the EXAMINE trial

“…In contrast to weight loss which was strongly and independently associated with a higher risk of all cardiovascular outcomes and mortality, weight gain ≥ 5% (but not ≥ 10%) was associated only with a higher risk of HF hospitalizations, suggesting that some of the increase in body weight may reflect congestion and fluid accumulation leading to HF [25]. Other observational studies in patients with T2D found that a weight gain was associated with a lower risk of cardiovascular outcomes [26].…”

Association of magnitude of weight loss and weight variability with mortality and major cardiovascular events among individuals with type 2 diabetes mellitus: a systematic review and meta-analysis

“…Characteristics of studies included in this systematic review and meta-analysis are presented in Table 1 and Additional file 2 : Table S1. Fourteen studies [ 6 – 8 , 10 , 12 , 15 , 18 – 26 ] were post-hoc analysis of prospective clinical trials. The sample size in the included studies ranged from 230 to 1,522,241.…”

“…Four studies [ 6 , 23 , 29 , 30 ] included only overweight or obese T2DM patients. Ten studies [ 9 , 11 , 18 , 22 , 24 , 28 , 31 – 34 ] excluded individuals with pre-existing CV comorbidities. One study [ 19 ] included T2DM patients with a recent acute coronary syndrome.…”

“…One study [ 19 ] included T2DM patients with a recent acute coronary syndrome. Ten studies [ 8 , 9 , 11 , 12 , 18 , 20 – 23 , 35 ] used a more than 2-year weight change interval to make sure that the change in weight was sustained. The follow-up time ranged from median 1.6 years (IQR: 1.0–2.1) to up to 26 years.…”

“…The follow-up time ranged from median 1.6 years (IQR: 1.0–2.1) to up to 26 years. In 19 studies [ 6 – 9 , 11 , 12 , 18 , 20 – 22 , 26 , 27 , 30 , 32 , 35 – 37 ], the median or mean follow-up time was of > 5 years. Other three studies [ 11 , 23 , 38 ] reported a maximum follow-up time more than 10 years.…”