Impact of Short-Term Medical Weight Loss on Atherosclerotic Cardiovascular Disease Risk in Patients with Obesity postprint

Abstract: Background  Patients with obesity exhibit a higher risk of atherosclerotic cardiovascular diseases（ASCVD）. The effects of short-term medical weight loss interventions on the risk level of ASCVD of patients with obesity at multidisciplinary outpatient department need to be elucidated. Objective  To explore the impact of short-term medical weight loss on ASCVD risk in patients with obesity. Methods  A retrospective analysis was conducted involving 172 patients with obesity who completed a 3-month weight loss treatment at the obesity multidisciplinary outpatient department in Nanjing Drum Tower Hospital. Demographics，clinical indicators，and cardiovascular disease risk of patient were documented using the Chinese adult ASCVD overall risk assessment flowchart. Based on baseline cardiovascular risk ratings，patients were categorized into a moderate-high risk group（n=58）and a low-risk group（n=114）. Moderate-high risk patients were further divided into the risk decreased subgroup（n=36）and the risk stable subgroup（n=22）based on whether their ASCVD risk decreased after treatment，and comparisons were made between the two subgroups regarding demographic and clinical data. Differences in clinical indicators and cardiovascular disease risk at baseline and post-treatment were analyzed，and multifactorial logistic regression analysis was conducted to identify factors related to reduction of the risk level of ASCVD in patients with moderate-high risk obesity. Results  Among the 172 patients，there were 73 males and 99 females，with an average age of 32（28，38）years，an average body weight of 89.8（82，101.2）kg，and an average BMI of 31.6（30.0，33.9）kg/m2 . After 3 months of treatment，the total weight loss（TWL）was 8.8%（5.6%，13.6%），and the BMI decreased to 28.8（27，30.7）kg/m2 . Measurements of waist circumference，waist-to-height ratio，body fat，body fat percentage，Fat Mass Index（FMI），Appendicular Skeletal Muscle Mass Index（ASMI），total muscle mass，visceral fat area（VFA），systolic blood pressure，diastolic blood pressure，and metabolic indicators（fasting glucose，postprandial blood glucose at 2 hours，fasting insulin，postprandial insulin at 2 hours，homeostatic model assessment of insulin resistance（HOMA-IR） triglycerides，cholesterol，low-density lipoprotein cholesterol，uric acid，alanine aminotransferase，and aspartate aminotransferase）all showed significant reductions compared to pre-treatment levels（P < 0.05）.Before treatment，114 patients were classified as the ASCVD low-risk group，while 58 patients were classified as the moderate-to-high-risk group. The BMI and body fat percentage of the moderate-to-high-risk group before treatment did not differ significantly from those of the low-risk group（P>0.05）；however，blood glucose levels were higher，lipid disorders were more pronounced，and transaminase levels were elevated（P<0.05）.Among the 58 patients with moderate to-high ASCVD risk before treatment，36 patients transitioned to low risk after 3 months of treatment（reduction subgroup），while 22 patients remained in the moderate-to-high-risk category（unchanged subgroup）. After 3 months of treatment，the body weight，BMI，waist circumference，waist-to-height ratio，body fat，body fat percentage，FMI，VFA，fasting insulin（FINS），postprandial insulin at 2 hours，insulin resistance index，triglycerides，alanine aminotransferase，and aspartate aminotransferase all decreased compared to pre-treatment levels in both subgroups. The reduction subgroup also showed decreases in systolic blood pressure，diastolic blood pressure，fasting blood glucose，cholesterol，and low-density lipoprotein cholesterol （P<0.05）. The reductions in BMI，body fat，body fat percentage，FMI，and VFA in the reduction subgroup were significantly greater than those in the unchanged subgroup（P<0.05）.Multivariate logistic regression analysis indicated that BMI（OR=1.257，95%CI=1.034-1.528，P=0.022）was an independent risk factor influencing the reduction of risk factors in obese patients with moderate-to-high ASCVD risk. For every 1 unit decrease in BMI，the ASCVD risk decreased by 25.7%. After 3 months of treatment，the proportion of patients at moderate-to-high ASCVD risk decreased in the Liraglutide group，Metformin group，and untreated group（P<0.05），with no significant differences in ASCVD risk levels or weight loss indicators among the three groups（P>0.05）. In the group with 28.0 kg/m2 ≤ BMI<32.5 kg/m2 and the group with BMI ≥ 32.5 kg/m2 ，the proportion of patients at moderate-to-high ASCVD risk decreased after 3 months of treatment，with the 28.0 kg/m2 ≤ BMI<32.5 kg/m2 group showing a greater reduction in the proportion of patients at moderate-to-high ASCVD risk compared to the BMI ≥ 32.5 kg/m2 group（P<0.05）. Both the female and male groups showed a decrease in the proportion of patients at moderate-to-high ASCVD risk after 3 months of treatment（P<0.05），with no significant differences in ASCVD risk levels between the two groups（P>0.05）. Comparisons between the 18-30 years group and the ≥ 30 years group also showed no significant differences in ASCVD risk levels（P>0.05）. Conclusion  Short-term medical weight loss in patients with obesity was benefit for effective weight loss and fat reduction，and improvement in ASCVD risk factors. However，for patients with a BMI ≥ 32.5 kg/m2 and with moderate-high cardiovascular risk level，such weight loss measures are not sufficient to reduce the risk level of ASCVD in the short term，and stronger and durable weight loss measures are the treatment of choice for these patients in the future.