Objective To study the effects of a comprehensive secondary prevention programme on weight loss and to identify determinants of weight change in patients with coronary artery disease (CAD). Methods We performed a secondary analysis focusing on the subgroup of overweight CAD patients (BMI ≥27 kg/m2) in the Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists-2 (RESPONSE-2) multicentre randomised trial. We evaluated weight change from baseline to 12-month follow-up; multivariable logistic regression with backward elimination was used to identify determinants of weight change. Results Intervention patients (n=280) lost significantly more weight than control patients (n=257) (−2.4±7.1 kg vs −0.2±4.6 kg; p<0.001). Individual weight change varied widely, with weight gain (≥1.0 kg) occurring in 36% of interventions versus 41% controls (p=0.21). In the intervention group, weight loss of ≥5% was associated with higher age (OR 2.94), lower educational level (OR 1.91), non-smoking status (OR 2.92), motivation to start with weight loss directly after the baseline visit (OR 2.31) and weight loss programme participation (OR 3.33), whereas weight gain (≥1 kg) was associated with smoking cessation ≤6 months before or during hospitalisation (OR 3.21), non-Caucasian ethnicity (OR 2.77), smoking at baseline (OR 2.70), lower age (<65 years) (OR 1.47) and weight loss programme participation (OR 0.59). Conclusion The comprehensive secondary prevention programme was, on average, effective in achieving weight loss. However, wide variation was observed. As weight gain was observed in over one in three participants in both groups, prevention of weight gain may be as important as attempts to lose weight. Trial registration number NTR3937. Data are available on reasonable request. Requests for analyses of deidentified data from this trial should be directed to: M Snaterse (m.snaterse@hva.nl).

中文翻译：

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冠心病患者体重管理和体重变化的决定因素

目的研究综合二级预防计划对体重减轻的影响，并确定冠状动脉疾病（CAD）患者体重变化的决定因素。方法 我们对门诊护士专家二级预防随机评估 (RESPONSE-2) 多中心随机试验中的超重 CAD 患者亚组 (BMI ≥ 27 kg/m2) 进行了二级分析。我们评估了从基线到 12 个月随访的体重变化；使用反向消除的多变量逻辑回归来确定体重变化的决定因素。结果 干预患者 (n=280) 的体重减轻明显多于对照组患者 (n=257)（-2.4±7.1 kg 与 -0.2±4.6 kg；p<0.001）。个体体重变化差异很大，体重增加（≥1. 0 kg) 发生在 36% 的干预中，而对照组为 41% (p=0.21)。在干预组中，体重减轻 ≥ 5% 与较高的年龄（OR 2.94）、较低的教育水平（OR 1.91）、不吸烟状态（OR 2.92）、基线访问后直接开始减肥的动机有关（ OR 2.31) 和参与减重计划 (OR 3.33)，而体重增加 (≥1 kg) 与住院前或住院期间 ≤ 6 个月戒烟 (OR 3.21)、非白种人 (OR 2.77)、基线吸烟有关(OR 2.70)、较低年龄 (<65 岁) (OR 1.47) 和减肥计划参与 (OR 0.59)。结论 综合二级预防计划平均能有效减轻体重。然而，观察到了广泛的变化。由于观察到两组超过三分之一的参与者体重增加，预防体重增加可能与尝试减肥一样重要。试用注册号 NTR3937。可应合理要求提供数据。对来自该试验的去识别化数据的分析请求应发送至：M Snaterse (m.snaterse@hva.nl)。