Excessive Body Weight Change Linked to Increased Risk of Cardiovascular Events in Type 2 Diabetes

Investigators sought to determine if an association existed between weight change and major cardiovascular outcomes among patients with type 2 diabetes.

Individuals with type 2 diabetes (T2D) who lost or gained more than 5% of their body weight within a 2-year period were found to be at increased risk for major cardiovascular events, according to the results of a study published in Diabetes Care.

Investigators identified 1,522,241 patients diagnosed with T2D and without a medical history of cardiovascular events using the National Health Insurance Service Database between 2009 and 2012 and followed them until December 2018.

The researchers categorized the patients into 5 groups according to percentage of body weight change within a 2-year period: those who lost greater than 10% of their body weight (n=47,992), those who lost between 5% and 10% of their body weight (n=187,891), those who either lost or gained up to 5% of their body weight (n=1,123,639), those who gained between 5% and 10% of their body weight (n=126,343), and those who gained more than 10% of their body weight (n=36,376).

During this period, the investigators recorded the occurrence of 32,106 myocardial infarctions, 44,406 ischemic strokes, 68,745 cases of heart failure, and 84,635 all-cause deaths.

Following data analysis, the researchers observed a U-shaped trend correlating weight loss and weight gain greater than 5% of baseline body weight with increased risk of experiencing a cardiovascular event. Individuals with T2D who experienced severe or moderate weight loss or gain were more likely to experience an ischemic stroke, heart attack, heart failure, or mortality compared with those whose weight remained stable within 5% of their body weight during a 2-year interval.

The observational design of the study prevented assessment as to what caused weight loss, such as exercise, medications, or other methods. In addition, during the middle of the study, the introduction of 2 new classes of antidiabetic medications to the Korean market caused significant weight loss in many patients. The investigators also were unable to generalize the study results to populations other than those with T2D.

“Increasing risks of cardiovascular events in association with weight gain are in line with previous reports…increasing risks of cardiovascular events in relation to weight loss, even with blood pressure reduction and lipid profile improvement, could be counterintuitive and surprising,” the authors said. “To our knowledge, this study is the first to show comprehensive relationships between body weight change and major cardiovascular events in a sizable T2DM cohort with a long-term follow-up.”


Park CS, Choi Y-J, Rhee T-M, et al. U-shaped associations between body weight changes and major cardiovascular events in type 2 diabetes mellitus: a longitudinal follow-up study of over 1.5 million nationwide cohort. Diabetes Care. Published online March 9, 2022:dc212299. doi:10.2337/dc21-2299