Weight Change and the Onset of Cardiovascular Diseases: Emulating Trials Using Electronic Health Records.

Michail Katsoulis,Manuel Gomes,Bianca D Stavola,R Thomas Lumbers,Pagona Lagiou,Alvina Lai,Claudia Langenberg,Amitava Banerjee,Karla Diaz-Ordaz,Konstantinos Tsilidis,Harry Hemingway,Constantinos A Parisinos,Spiros Denaxas,Rachel Batterham,Goya Wannamethee,Riyaz Patel

doi:10.1097/ede.0000000000001393

Abstract

Cross-sectional measures of body mass index (BMI) are associated with cardiovascular disease (CVD) incidence, but less is known about whether weight change affects the risk of CVD. We estimated the effect of 2-y weight change interventions on 7-y risk of CVD (CVD death, myocardial infarction, stroke, hospitalization from coronary heart disease, and heart failure) by emulating hypothetical interventions using electronic health records. We identified 138,567 individuals with 45-69 years of age without chronic disease in England from 1998 to 2016. We performed pooled logistic regression, using inverse-probability weighting to adjust for baseline and time-varying confounders. We categorized each individual into a weight loss, maintenance, or gain group. Among those of normal weight, both weight loss [risk difference (RD) vs. weight maintenance = 1.5% (0.3% to 3.0%)] and gain [RD = 1.3% (0.5% to 2.2%)] were associated with increased risk for CVD compared with weight maintenance. Among overweight individuals, we observed moderately higher risk of CVD in both the weight loss [RD = 0.7% (-0.2% to 1.7%)] and the weight gain group [RD = 0.7% (-0.1% to 1.7%)], compared with maintenance. In the obese, those losing weight showed lower risk of coronary heart disease [RD = -1.4% (-2.4% to -0.6%)] but not of stroke. When we assumed that chronic disease occurred 1-3 years before the recorded date, estimates for weight loss and gain were attenuated among overweight individuals; estimates for loss were lower among obese individuals. Among individuals with obesity, the weight-loss group had a lower risk of coronary heart disease but not of stroke. Weight gain was associated with increased risk of CVD across BMI groups. See video abstract at, http://links.lww.com/EDE/B838.

Highlights

Lifestyle[1] and pharmacotherapy interventions[2,3] have been shown in randomized controlled trials (RCTs) to be effective in achieving weight loss among individuals with overweight or obesity
Among those of normal weight, both weight loss [risk difference (RD) vs. weight maintenance = 1.5% (0.3% to 3.0%)] and gain [RD = 1.3% (0.5% to 2.2%)] were associated with increased risk for cardiovascular disease (CVD) compared with weight maintenance
When we assumed that chronic disease occurred 1–3 years before the recorded date, estimates for weight loss and gain were attenuated among overweight individuals; estimates for loss were lower among obese individuals

Summary

Introduction

Lifestyle[1] and pharmacotherapy interventions[2,3] have been shown in randomized controlled trials (RCTs) to be effective in achieving weight loss among individuals with overweight or obesity. Studies looking at people with severe obesity who had bariatric surgery experienced particular reductions in risk.[20] Weight gain has been associated with increased CVD risk in some studies,[13,14,15,16] but not others.[21] The Nurses’ Health Study has emulated weight-loss trials (i.e., in a consented cohort), which found no relationship between weight loss and CHD.[17,18] To our knowledge, there have been no previous emulation of weight-loss trials reporting separate effects within groups of people with normal weight, overweight, or obesity.

Methods

Results

Discussion

Conclusion