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How Much Weight Loss Is Required For Cardiovascular Benefits? Insights From A Metabolic Surgery Matched Cohort Study
*Ali Aminian1, *Alexander Zajichek1, *Kathy E Wolski1, Stacy A Brethauer2, Philip R Schauer3, *Michael W Kattan1, *Steven E Nissen1
1Cleveland Clinic, Cleveland, OH;2Ohio State University Wexner Medical Center, Columbus, OH;3Pennington Biomedical Research Center, Baton Rouge, LA

OBJECTIVE(S): The minimum amount of weight loss needed to see a beneficial reduction in major adverse cardiovascular events (MACE) is unknown.
METHODS: Patients with obesity (BMI≥30 kg/m2) and type 2 diabetes who underwent metabolic surgery in an academic center (1998-2017) were propensity-matched 1:5 to nonsurgical patients who received usual care. The adjusted linear and non-linear effects of weight-loss (achieved in the first 18 months after the index date) was studied to identify cut-offs for the minimum weight loss to achieve decreased risk of MACE (composite of all-cause mortality, coronary artery events, cerebrovascular events, heart failure, nephropathy, and atrial fibrillation).
RESULTS:A total of 7201 patients (1223 surgical and 5978 non-surgical) with a median follow-up time of 4.9 years (IQR, 3.5-7) were included. The positive effect of metabolic surgery was still present after adjusting for weight loss amounts (Figure-1A), suggesting that there are weight loss-independent factors contributing to a reduction in risk of MACE in the surgical cohort. After considering the weighted estimates from a diverse set of models, the risk of MACE decreased after 10% of weight is lost in surgical group and 20% in the nonsurgical group (Figure-1B).
CONCLUSIONS:This large matched-cohort study identified the minimum weight loss thresholds for reduction in risk of MACE in patients with obesity and diabetes. Furthermore, these findings suggest the presence of weight-independent beneficial effects of metabolic surgery on MACE.


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