Sweden: A SWEDEHEART analysis of 124,360 patients with myocardial infarction, including 21% with diabetes, has found that severe obesity and diabetes substantially increased long-term cardiovascular risk.

Over a mean follow-up of 6 years, patients with class 3 obesity and diabetes had more than twice the risk of all-cause mortality (HR 2.15) and a 91% higher risk of major adverse cardiovascular events (MACE). Severe obesity was particularly associated with heart failure and kidney complications, highlighting the importance of aggressive weight and diabetes management after MI.
The findings were published in the European Journal of Preventive Cardiology by Viveca Ritsinger, Division of Cardiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden, and colleagues.
Obesity is an established cardiovascular risk factor, but its long-term impact after myocardial infarction may vary according to the severity of obesity and the presence of diabetes. To better understand these associations, researchers examined data from the nationwide Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART) registry.
The study included patients who experienced myocardial infarction between 2010 and 2021. Participants were followed until December 2021, with an average follow-up of approximately six years. Researchers assessed outcomes across different body mass index categories and compared risks according to diabetes status.
Among the 124,360 participants, 21% had diabetes. Obesity, defined as a BMI of 30 kg/m² or higher, was more prevalent among patients with diabetes than those without diabetes, affecting 37% versus 20%, respectively.
Key findings included:
  • Patients with class 3 obesity (BMI ≥40 kg/m²) and diabetes had the highest risk of all-cause mortality, with more than twice the risk compared with individuals with normal BMI and no diabetes (HR 2.15).
  • The same group had a 91% higher risk of MACE, which included death from any cause, recurrent myocardial infarction, stroke or heart failure (HR 1.91).
  • Class 3 obesity without diabetes was associated with a comparatively lower 29% increase in MACE risk (HR 1.29).
  • Among patients without diabetes, increased risks of death and MACE were mainly observed in those with class 2 or class 3 obesity, rather than those who were overweight or had class 1 obesity.
  • Obesity showed a stronger relationship with heart failure and renal complications than with recurrent myocardial infarction or stroke.
  • The highest risks of heart failure and renal events occurred in patients with class 3 obesity and diabetes, with HRs of 2.92 and 3.36, respectively.
The researchers emphasized that severe obesity and diabetes identify a particularly high-risk group after myocardial infarction. Including obesity severity and diabetes status in post-MI risk assessment may help guide more intensive preventive care.
The findings also support targeted weight management and cardiometabolic interventions, particularly for patients with severe obesity and diabetes, who may benefit most from effective weight-reducing therapies.
Reference:
Ritsinger, V., Lagerqvist, B., Ekström, M., Hagström, E., & Norhammar, A. Obesity and Cardiovascular Outcomes After Myocardial Infarction - a nationwide SWEDEHEART analysis by diabetes status. European Journal of Preventive Cardiology. https://doi.org/10.1093/eurjpc/zwag367
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Article Source : European Journal of Preventive Cardiology

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Medha Baranwal

Medha Baranwal holds a Bachelor’s degree in Biomedical Sciences from the University of Delhi and a Master’s degree in Biotechnology from Amity University. Since May 2018, she has been contributing to Medical Dialogues, writing and editing medical news articles that translate complex research into clear, accessible information for healthcare professionals.

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