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Is the obesity paradox leading to a less stringent secondary prevention strategy in patients who have sustained an acute coronary syndrome?
Session:
Comunicações Orais (Sessão 25) - Risco CV, Prevenção e Reabilitação Cardíaca 2 - Vários
Speaker:
André Dias de Frias
Congress:
CPC 2022
Topic:
J. Preventive Cardiology
Theme:
28. Risk Factors and Prevention
Subtheme:
28.6 Obesity
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Dias de Frias; Cristine Schmidt; Mauro Moreira; Preza Fernandes; Sandra Magalhães; Mário Santos; Severo Torres
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="color:black">Introduction</span></u><span style="color:black">: Patients with acute coronary syndrome (ACS) are at very high risk of recurrent cardiovascular (CV) events. Despite being a major CV risk factor, obesity was associated with best survival in patients with ACS, the so-called “obesity paradox”. It is uncertain if this finding is leading to a less stringent secondary prevention strategy in this group of patients, and whether it influences prognosis.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="color:black">Aim</span></u><span style="color:black">: To analyze the impact of obesity on outcomes after ACS and on other CV risk factor management.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="color:black">Methods</span></u><span style="color:black">: Single-center, retrospective observational study that included all consecutive post-ACS patients enrolled in a phase 2 cardiac rehabilitation (CR) program in 2017. Patients were classified in 2 groups according to body mass index (BMI) classification at baseline: Group 1 (G1) were obese patients (BMI</span><span style="color:black">≥</span><span style="color:black">30 kg/m<sup>2</sup>), and Group 2 (G2) were non-obese patients (BMI<30kg/m<sup>2</sup>).</span><span style="color:black"> Major adverse cardiovascular events (MACE) were defined as a composite of death, non-fatal ACS, non-fatal stroke, and unplanned revascularization. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="color:black">Results</span></u><span style="color:black">: 198 patients were included (mean age of 60.3±10.7 years, 82% male) with a mean BMI of 27.7±4.2 kg/m<sup>2</sup>. Forty-seven patients had a BMI</span><span style="color:black">≥</span><span style="color:black">30 kg/m<sup>2</sup>. Patients in G1 were more likely to have hypertension (79% vs 55%; p=0.003) and diabetes (36% vs 20%; p=0.022). CR program was associated with smoking cessation, significant BMI (G1: -0.69 (95%CI: -0.40 to -0.10); G2: -0.39 (95%CI: -0.20 to -0.57) and LDL-Cholesterol (LDL-C) reduction (G1: -38 (95%CI: -25 to -50); G2: -29 (95%CI: -22 to -36), and functional capacity improvement (G1: +1.2 METs (95%CI: +0.9 to +1.5); G2: +1.1 METs (95%CI: +1.0 to +1.4) in both groups at 3 months, with similar magnitude of improvement. At 24 months, BMI had returned to baseline values in both groups, while the improvement in smoking status, LDL-C and functional capacity persisted. At 24 months, MACE occurrence was numerically increased in obese group (G1: 26.1% vs. G2: 17.2%, p=0.182), with a statistically significant higher incidence of non-fatal recurrent ACS (reACS) in G1 (17% vs. 7.3%, p=0.048).</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="color:black">Conclusions</span></u><span style="color:black">: ACS patients with obesity have worse prognosis, despite the similar improvement in CV risk profile. Our data also suggests that, despite the short-term improvement in BMI, current treatment strategies are not effective in achieving a persistent weight control over 24-months. </span></span></span></p>
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