454-P: Weight Loss and Type 2 Diabetes Are Mutually Independent Predictors of Mortality in Patients with Established Coronary Artery Disease

Obesity is a major risk factor for type 2 diabetes (T2DM), coronary artery disease (CAD) and premature mortality. This, however, does not necessarily imply that weight loss in patients who already have established CAD is associated with an improved outcome. In this study, we prospectively investigated the association of weight loss with mortality in a consecutive series of 483 patients with angiographically proven CAD. Weight was measured at baseline and after 4 years, and deaths were recorded over a mean follow-up period of 11.5±3.9 years. At baseline, weight was significantly higher in patients with T2DM (n=137) than in nondiabetic subjects (83±14 vs. 78±14 kg, p=0.003, amounting to BMI scores of 28.9±3.9 vs. 27.4±3.8 kg/m²; p<0.001). Prospectively, 56 (42.4%) of the patients with T2DM and 104 (31.2%) of the nondiabetic patients died (p=0.022); weight loss occurred in 76.6% of the patients with T2DM and in 73.4% of the patients who did not have diabetes (p=0.464). The amount of weight loss significantly predicted cardiovascular mortality univariately (standardized HR 1.14 [1.03-1.27]; p=0.013), as well as after multivariate adjustment including T2DM status (standardized adjusted HR 1.18 [1.05-1.33]; p=0.005). Conversely, T2DM remained a significant predictor of mortality after multivariate adjustment including weight loss (HR 1.67 [1.19-2.33]; p=0.003). We conclude that weight loss and T2DM are mutually independent predictors of mortality in patients with established CAD.