Obesity and Beyond: Lifestyle Patterns and Cardiometabolic Burden in High-Risk Patients with Coronary Artery...

Obesity substantially increases cardiovascular risk and contributes to the accumulation of cardiometabolic risk factors. Achieving optimal control of body weight and guideline-recommended targets is essential in high-risk patients, particularly in secondary prevention following acute coronary events. This study aimed to evaluate treatment strategies and lifestyle modifications undertaken by patients with obesity during long-term follow-up.

This analysis included patients enrolled 6-18 months after acute coronary syndrome or coronary revascularization within the multicentre POLASPIRE II study. Standardized EUROASPIRE methodology was applied to collect clinical, anthropometric, and lifestyle-related data.

A total of 788 patients (mean age 65.4 ± 8.9 years; 25.8% women) were included, of whom 40.6% had obesity. No significant association between sex and BMI was observed (β = -0.48; 95% CI -1.30 to 0.31; p = 0.20). Increasing age was associated with lower BMI (β = -0.05; 95% CI -0.09 to -0.0001; p = 0.044), and higher education correlated with lower BMI (β = -1.10; 95% CI -2.00 to -0.22; p = 0.015). With advancing age (OR 1.02; 95% CI 1.002-1.033; p = 0.023) and increasing BMI (OR 1.11; 95% CI 1.076-1.138; p = 0.001), the number of risk factors and comorbidities increased. Higher BMI was associated with poorer control of medical risk factors (OR 1.06; 95% CI 1.03-1.10; p < 0.001), whereas patients with higher BMI demonstrated better control of lifestyle-related risk factors (OR 0.95; 95% CI 0.919-0.983; p = 0.003).

Obesity is highly prevalent among high-risk cardiovascular patients and is associated with a greater burden of comorbidities and poorer control of medical risk factors. These findings support the need for strengthened, risk-stratified secondary prevention strategies and more personalized therapeutic approaches in patients with obesity.