The Risks of Cardiovascular Disease and Mortality Following Weight Change in Adults with Diabetes: Results from ADVANCE.

TitleThe Risks of Cardiovascular Disease and Mortality Following Weight Change in Adults with Diabetes: Results from ADVANCE.
Publication TypeJournal Article
Year of Publication2020
AuthorsLee AK, Woodward M, Wang D, Ohkuma T, Warren B, Sharrett ARichey, Williams B, Marre M, Hamet P, Harrap S, McEvoy JW, Chalmers J
Secondary AuthorsSelvin E
JournalJ Clin Endocrinol Metab
Volume105
Issue1
Date Published2020 01 01
ISSN1945-7197
KeywordsAdult, Aged, Body-Weight Trajectory, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Drug Combinations, Female, Follow-Up Studies, Gliclazide, Humans, Hypertension, Indapamide, Life Style, Male, Middle Aged, Obesity, Overweight, Perindopril, Risk Factors, Weight Gain, Weight Loss
Abstract

CONTEXT: Weight loss is strongly recommended for overweight and obese adults with type 2 diabetes. Unintentional weight loss is associated with increased risk of all-cause mortality, but few studies have examined its association with cardiovascular outcomes in patients with diabetes.

OBJECTIVE: To evaluate 2-year weight change and subsequent risk of cardiovascular events and mortality in established type 2 diabetes.

DESIGN AND SETTING: The Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation was an international, multisite 2×2 factorial trial of intensive glucose control and blood pressure control. We examined 5 categories of 2-year weight change: >10% loss, 4% to 10% loss, stable (±10% gain. We used Cox regression with follow-up time starting at 2 years, adjusting for intervention arm, demographics, cardiovascular risk factors, and diabetes medication use from the 2-year visit.

RESULTS: Among 10 081 participants with valid weight measurements, average age was 66 years. By the 2-year examination, 4.3% had >10% weight loss, 18.4% had 4% to 10% weight loss, and 5.3% had >10% weight gain. Over the following 3 years of the trial, >10% weight loss was strongly associated with major macrovascular events (hazard ratio [HR], 1.75; 95% confidence interval [CI], 1.26-2.44), cardiovascular mortality (HR, 2.76; 95% CI, 1.87-4.09), all-cause mortality (HR, 2.79; 95% CI, 2.10-3.71), but not major microvascular events (HR, 0.91; 95% CI, 0.61-1.36), compared with stable weight. There was no evidence of effect modification by baseline body mass index, age, or type of diabetes medication.

CONCLUSIONS: In the absence of substantial lifestyle changes, weight loss may be a warning sign of poor health meriting further workup in patients with type 2 diabetes.

DOI10.1210/clinem/dgz045
Alternate JournalJ Clin Endocrinol Metab
PubMed ID31588504
PubMed Central IDPMC6936964
Grant ListR01 DK108784 / DK / NIDDK NIH HHS / United States
28562 / BHF_ / British Heart Foundation / United Kingdom
T32 HL007024 / HL / NHLBI NIH HHS / United States
T32 AG000212 / AG / NIA NIH HHS / United States
K24 DK106414 / DK / NIDDK NIH HHS / United States