Key result
Post-ACS weight loss linked to ~10% lower 5-year MACE risk per 5% lost.
Why the study?
Overweight and obesity are common after acute coronary syndromes, but the long-term cardiovascular consequences of post-ACS weight change remain uncertain.
Does 1-year weight loss reduce 4-point MACE over 5 years in overweight and obese patients following acute coronary syndromes?
Cohort (n=1,473)
Yes
Does 1-year weight loss reduce 4-point MACE over 5 years in overweight and obese patients following acute coronary syndromes?
Hazard Ratio: 0.9 (95% CI 0.82–1)
Absolute Event Rate: 19.4% vs 21.7%
p-value: p=0.04
In overweight and obese patients following an acute coronary syndrome, weight loss over the first year is associated with a significantly reduced risk of major adverse cardiovascular events at 5 years.
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May support weight management counseling post-ACS; extends observational data but leaves causal benefit open pending RCTs.
Aims Overweight and obesity are common among patients with acute coronary syndromes (ACS), yet the long-term cardiovascular consequences of post-ACS weight change remain uncertain. We investigated the association between 1-year weight change after ACS and 5-year clinical outcomes in overweight and obese patients. Methods We analyzed 1,473 overweight and obese ACS participants from the Swiss ELIPS cohort with available weight measurements. Hazard ratios (HRs) were estimated per 1% and 5% weight change for the 5-year risk of major adverse cardiovascular events (MACE), defined as cardiovascular death, non-fatal myocardial infarction, coronary revascularization, stroke, or transient ischemic attack. Models were adjusted for age, sex, BMI, smoking, total cholesterol, hypertension, diabetes, and eGFR. Predefined subgroups included BMI ≥27 kg/m2 versus 25–27 kg/m2. Results Among the participants (15.1% women, mean age 61.5 years), the median BMI was 28.1 kg/m2 (67% BMI ≥27 kg/m2). Median 1-year weight change was 0%; 47.5% lost weight and 18.7% achieved >5% weight loss. Patient characteristics associated with weight loss were older age, higher BMI, non-smoking status, and participation in cardiac rehabilitation. During follow-up, 278 MACE events occurred. Weight loss was associated with a lower risk of MACE (multivariate-adjusted HR per 5%: 0.90, 95% CI: 0.82–1.00, p=0.04). The association was stronger in patients with BMI ≥ 27 kg/m2 (adj HR per 5% 0.87, 95% CI: 0.77-0.97) compared to those with BMI 25-27 kg/m2 (adj HR per 5% 1.01, 95% CI: 0.85-1.20, interaction p = 0.16). Conclusion Overweight and obese ACS patients who lose weight may have a lower risk of cardiovascular events.
Artels et al. (2026) conducted a cohort in Acute Coronary Syndromes (ACS) in overweight and obese patients (n=1,473). Weight loss (per 5% decrease) vs. Weight gain or stable weight was evaluated on 4-point Major Adverse Cardiovascular Events (MACE: cardiovascular death, non-fatal myocardial infarction, coronary revascularization, stroke, or transient ischemic attack) (HR 0.90, 95% CI 0.82-1.00, p=0.04). Each 5% weight loss during the first year after acute coronary syndrome in overweight and obese patients was associated with a 10% lower 5-year risk of major adverse cardiovascular events (HR 0.90).
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