|Title||The Risks of Cardiovascular Disease and Mortality Following Weight Change in Adults with Diabetes: Results from ADVANCE.|
|Publication Type||Journal Article|
|Year of Publication||2020|
|Authors||Lee AK, Woodward M, Wang D, Ohkuma T, Warren B, Sharrett ARichey, Williams B, Marre M, Hamet P, Harrap S, McEvoy JW, Chalmers J|
|Secondary Authors||Selvin E|
|Journal||J Clin Endocrinol Metab|
|Date Published||2020 01 01|
|Keywords||Adult, 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|
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.
|Alternate Journal||J Clin Endocrinol Metab|
|PubMed Central ID||PMC6936964|
|Grant List||R01 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