Predictors of weight change in overweight patients with myocardial infarction - 15/08/11
Résumé |
Background |
Weight loss is recommended among overweight survivors of myocardial infarction (MI). This study describes patterns of weight change among overweight patients with MI and identifies factors associated with weight change.
Methods |
A prospective cohort of 1253 overweight or heavier (body mass index [BMI] ≥25 kg/m2) post-MI patients were enrolled in the 19-center PREMIER study and followed up for 1 year to determine changes in weight. Patients were categorized at 1 month as overweight (BMI = 25-29.9 kg/m2), obese (BMI = 30-39.9 kg/m2), or morbidly obese (BMI ≥40 kg/m2). Unadjusted percent weight change was assessed at 1 year, and multivariable linear regression was used to identify independent correlates of change.
Results |
Mean weight change was −0.2% and varied by the severity of baseline obesity (+0.4% for overweight patients, −0.5% for obese patients, and −3.7% for morbidly obese patients [P < .001]). Multivariable analyses revealed the following to be significantly associated with weight change: depression 1 month post-MI (+2.7%, P = .001), lack of health insurance (+2%, P = .01), smoking cessation 1 month post-MI (+2.7% vs current smokers, P < .001), morbid obesity (+4.7% vs overweight patients, P < .0001), and increasing age (−0.8% per decade, P = .001). An interaction between smoking cessation and weight class was detected in that overweight patients who quit had a mean increase of 5.3% (95% CI 3.1%-7.4%), whereas no significant change was observed among obese and morbidly obese patients who quit.
Conclusions |
Although post-MI patients had negligible weight loss over 1 year, several sociodemographic, clinical, and lifestyle characteristics were associated with weight change. New, targeted interventions will likely be needed to improve weight management after an MI.
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This work was supported by CV Therapeutics, Palo Alto, CA, and CV Outcomes, Inc (Kansas City, MO). Dr Spertus discloses that he has leadership responsibilities for CV Outcomes, Inc, Health Outcomes Sciences, and Outcomes Instruments; is a consultant for Amgen and United Healthcare; receives research grant support from the National Institutes of Health, Amgen, Lilly, Roche Diagnostics, and the American College of Cardiology-National Cardiovascular Data Registry; owns the copyrights for the Seattle Angina Questionnaire, the Kansas City Cardiomyopathy Questionnaire, and the Peripheral Artery Questionnaire; and previously received grant support and was a consultant for CV Therapeutics. Dr Masoudi discloses he has served on advisory boards for Takeda NA, Amgen, and United Healthcare; has contracts with the Oklahoma Foundation for Medical Quality; and is an associate editor of Journal Watch Cardiology of the Massachusetts Medical Society. Dr Krumholz discloses that he has research contracts with the Colorado Foundation for Medical Care and the American College of Cardiology, serves on the advisory boards for Amgen, Alere, and UnitedHealthcare, is a subject matter expert for VHA, Inc, and is editor-in-chief of Journal Watch Cardiology. No other authors have conflicts of interest to disclose related to this article. |
Vol 154 - N° 4
P. 711-717 - octobre 2007 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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