Weight loss as a predictor of cardiovascular and all-cause death: a 34-year prospective cohort follow-up

Aim. To study the influence of body weight changes as a factor determining the risk of cardiovascular and all-cause death in a 34-year prospective follow-up of a Tomsk population cohort.

Material and methods. This 34-year prospective study included 1546 people aged 20-59 years. In 1988-1991, anthropometric measurement and calculation of body mass index were performed, while in 20022005 — re-examination of the cohort with body weight assessment. In 2022, we studied the effect of body weight changes on cardiovascular and all-cause mortality.

Results. Prior body weight decreases by more than 5% is accompanied by an increase in all-cause death risk by 1,6 times compared to individuals with stable weight, and 2,3 times higher compared to those with body weight increased during the follow-up period. Cardiovascular death risk in the case of body weight decrease is 1,7 and 3 times higher, respectively. The best 17-year survival was established among individuals with an increase who had an increase in BW by more than 5%.

Conclusion. A decrease in body weight by more than 5% is an independent predictor of cardiovascular and all-cause death. When assessing the cardiovascular and all-cause death risks, not only the current body weight should be taken into account, but also the previous direction of its changes.

1. Zou H, Yin P, Liu L, et al. Body-Weight Fluctuation Was Associated with Increased Risk for Cardiovascular Disease, All-Cause and Cardiovascular Mortality: A Systematic Review and Meta-Analysis. Front Endocrinol. 2019;10:728. doi:10.3389/fendo.2019.00728.

2. Chen C, Ye Y, Zhang Y, et al. Weight change across adulthood in relation to all cause and cause specific mortality: prospective cohort study. BMJ. 2019;367:l5584. doi:10.1136/bmj.l5584.

3. Degoulet P, Legrain M, Réach I. Mortality risk factors in patients treated by chronic hemodialysis. Report of the Diaphane collaborative study. Nephron. 1982;31(2):103-10. doi:10.1159/000182627.

4. Kalantar-Zadeh K, Block G, Horwich T, et al. Reverse epidemiology of conventional cardiovascular risk factors in patients with chronic heart failure. J Am Coll Cardiol. 2004;43(8):1439-44. doi:10.1016/j.jacc.2003.11.039.

5. Shpagina OV, Bondarenko IZ. "Obesity Paradox" — another look at the problem of cardiovascular disease. Obesity and metabolism. 2013;10(4):3-9. (In Russ.) doi:10.14341/omet201343-9.

6. Zhang J, Schutte R, Pierscionek B.Association of weight change with cardiovascular events and all-cause mortality in obese participants with cardiovascular disease: a prospective cohort study. Heart. 2025;111(10):454-61. doi:10.1136/heartjnl-2024-324383.

7. Dolgalev IV, Trotsenko BA, Obraztsov VV, et al. Natural dynamics of overweight in adults (according to the results of a 17-year prospective study). Sibirskij meditsinskij zhurnal (Tomsk). 2011; 3(1):148-52. (In Russ.)

8. Dolgalev IV, Brazovskaya NG, Ivanova AYu, et al. Impact of hypertension, overweight, hypertriglyceridemia and their combination for mortality rate according to the results of a 27-year cohort prospective study. Kardiologiia. 2019;59(S11):44-52. (In Russ.) doi:10.18087/cardio.n344.

9. Dolgalev IV, Ivanova AYu. The risk of overall mortality and cardiovascular mortality depending on the direction of body weight dynamics: a prospective cohort study. Russian Journal of Preventive Medicine. 2022;25(4):41 6. (In Russ.) doi:10.17116/profmed20222504141.

10. Piepoli М, Hoes А, Agewall S, et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2016). Eur Heart J. 2016;37(29):2315-81. doi:10.1016/j.atherosclerosis.2016.05.037.

11. Whitlock G, Lewington S, Sherliker P. Body-mass index and causespecific mortality in 900000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009;373:1083-96. doi:10.1016/S0140-6736(09)60318-4.

12. The Global BMI Mortality Collaboration. Body-mass index and allcause mortality: individual participant-data meta-analysis of 239 prospective studies in four continents. Lancet. 2016;388:776-86. doi:10.1016/S0140-6736(16)30175-1.

13. Aune D, Sen A, Prasad M, et al. BMI and all cause mortality: systematic review and non-linear dose–response metaanalysis of 230 cohort studies with 3,74 million deaths among 30,3 million participants. BMJ. 2016;353:i2156. doi:10.1136/bmj.i2156.

14. Druzhilov MA, Kuznetsova ТYu, Druzhilova ОYu. "Obesity paradoxes": main causes of an "inverse" cardiovascular epidemiology. Cardiovascular Therapy and Prevention. 2018;17(5):92-8. (In Russ.) doi:10.15829/1728-8800-2018-5-92-98.

15. Hong NS, Kim KS, Lee IK. The association between obesity and mortality in the elderly differs by serum concentrations of persistent organic pollutants: a possible explanation for the obesity paradox. Int J Obes (Lond). 2012;36(9):1170-5. doi:10.1038/ijo.2011.187.

16. Feldman AM, Combes A, Wagner D. The role of tumor necrosis factor in the pathophysiology of heart failure. J Am Coll Cardiol. 2000;35(3):537-44. doi:10.1016/s0735-1097(99)00600-2.

17. Pocock SJ, McMurray JJ, Dobson J. Weight loss and mortality risk in patients with chronic heart failure in the candesartan in heart failure: assessment of reduction in mortality and morbidity (CHARM) programme. Eur Heart J. 2008;29(21):2641-50. doi:10.1093/eurheartj/ehn420.

18. Rafiei SKS, Fateh F, Arab M, et al. Weight Change and the Risk of Micro and Macro Vascular Complications of Diabetes: A Systematic Review. Malays J Med Sci. 2024;31(3):18-31. doi:10.21315/mjms2024.31.3.2.

19. Williamson DF, Thompson TJ, Thun M, et al. Intentional weight loss and mortality among overweight individuals with diabetes. Diabetes Care. 2000;23(10):1499-504. doi:10.2337/diacare.23.10.1499.

20. Huang QM, Shen D, Gao J, et al. Association of weight change with all-cause and cause-specific mortality: an age-stratified analysis. BMC Med. 2024;22(1):438. doi:10.1186/s12916-024-03665-9.

21. Yang H, Wang J, Wang X, et al. Weight change and all-cause and cause-specific mortality: A 25-year follow-up study. Chin Med J (Engl). 2024;137(10):1169-78. doi:10.1097/CM9.0000000000002970.

22. Wei J, Hunter D, Lane NE, et al. Weight Loss Induced by Antiobesity Medications and All-Cause Mortality Among Patients With Knee or Hip Osteoarthritis. Arthritis Rheumatol. 2024;76(4):577-86. doi:10.1002/art.42754.

23. Holmes R, Duan H, Bagley O, et al. How are APOE4, changes in body weight, and longevity related? Insights from a causal mediation analysis. Front Aging. 2024;5:1359202. doi:10.3389/fragi.2024.1359202.

24. Yashin A, Arbeeva LS, Arbeev KG, et al. Age trajectories of physiological indices: which factors influence them? In: The Springer Series on Demographic Methods and Population Analysis (Dordrecht: Springer). Biodemography of Aging. 2016;40:21-45. doi:10.1007/978-94-017-7587-8_2.

25. Ukraintseva S, Duan M, Arbeev K, et al. Interactions Between Genes From Aging Pathways May Influence Human Lifespan and Improve Animal to Human Translation. Front Cell Dev Biol. 2021;9:692020. doi:10.3389/fcell.2021.692020.