Evolution of anthropometrics parameters in overweight patients with chronic coronary syndromes

Background Guidelines recommend weight and waist circumference (WC) reduction for overweight patients with chronic coronary syndromes (CCS). However, data regarding natural anthropometric trajectories and their association with cardiovascular (CV) outcomes remain scarce. Prior to the widespread use of GLP-1 receptor agonists, evaluating the real-world prognostic impact of non-pharmacological anthropometric variations is critical. Purpose To characterize longitudinal anthropometric changes in CCS patients and evaluate their association with subsequent CV outcomes. Methods The CLARIFY registry enrolled over 32,000 patients with CCS, collecting annual weight, body mass index (BMI), and WC data over a 5-year follow-up. Patients with a baseline BMI ≥ 25 kg/m2 were included. Longitudinal trends of anthropometric parameter evolution were assessed via linear mixed-effects models. For patients alive at 2 years with at least two measurements of each parameter, individual change slopes were calculated via linear regression. A 2-year landmark analysis was conducted for CV death and myocardial infarction (MI) and all-cause mortality. Multivariable Cox regression, adjusted for established CCS risk factors for adverse events, and restricted cubic splines (RCS) mapped associations between continuous anthropometric slopes and clinical outcomes. Results Among 23,858 overweight patients with CCS, 5-year trends showed modest but significant decreases in weight (-0.13 kg/year) and BMI (-0.01 kg/m²/year), and increases in WC (+0.03 cm/year) and WC/BMI ratio (+0.01 /year) (all p<0.001). At the 2-year landmark analysis including 21,557 patients, mean yearly slopes were -0.21±3.4 kg for weight, -0.07±1.21 for BMI, +0.04±4.4 cm for WC, and +0.01±0.16 for WC/BMI. During the subsequent 3-year follow-up, 974 (4.5%) CV death/MI events and 1,036 (4.8%) all-cause deaths occurred. RCS revealed non-linear associations between anthropometric changes and outcomes. Any degree of weight declines linearly correlated with increased CV death/MI (aHR 1.04 per kg lost/year, 95%CI 1.03-1.06, p<0.001) and all-cause death (aHR 1.07, 95%CI 1.05-1.08, p<0.001). Results were similar with BMI. Moderate increase in weight (<2 kg/year) and BMI, alongside modest WC/BMI reductions were associated with reduced all-cause death, but not improved CV outcomes. Conclusion In CCS, natural anthropometric variations are remarkably modest. Any degree of weight or BMI loss is linearly associated with increased mortality and CV events, whereas modest WC/BMI reduction improves survival. This suggests that clinically significant spontaneous weight loss is rare, and when present, it most often reflects underlying disease or frailty rather than deliberate health improvement.Assoc. of anthropometric evol. with outcomes