Patients with obesity exhibit a higher risk of atherosclerotic cardiovascular diseases (ASCVD). The effects of short-term medical weight loss interventions on the risk level of ASCVD of patients with obesity at multidisciplinary outpatient department need to be elucidated.

To explore the impact of short-term medical weight loss on ASCVD risk in patients with obesity.

A retrospective analysis was conducted involving 172 patients with obesity who completed a 3-month weight loss treatment at the obesity multidisciplinary outpatient department in Nanjing Drum Tower Hospital from July 2019 to May 2024. Demographics, clinical indicators, and cardiovascular disease risk of patient were documented using the Chinese adult ASCVD overall risk assessment flowchart. Based on baseline cardiovascular risk ratings, patients were categorized into a moderate-high risk group (n=58) and a low-risk group (n=114). Moderate-high risk patients were further divided into the risk decreased subgroup (n=36) and the risk stable subgroup (n=22) based on whether their ASCVD risk decreased after treatment, and comparisons were made between the two subgroups regarding demographic and clinical data. Differences in clinical indicators and cardiovascular disease risk at baseline and post-treatment were analyzed, and multifactorial logistic regression analysis was conducted to identify factors related to reduction of the risk level of ASCVD in patients with moderate-high risk obesity. ASCVD risk and weight loss indicators among different medication groups and patients stratified by BMI, gender, and age after 3 months of treatment were analysised.

Among the 172 patients, there were 73 males and 99 females, with an average age of 32 (28, 38) years, an average body weight of 89.8 (82.0, 101.2) kg, and an average BMI of 31.6 (30.0, 33.9) kg/m². After 3 months of treatment, the total weight loss was 8.8% (5.6%, 13.6%), and the BMI decreased to 28.8 (27.0, 30.7) kg/m². Measurements of waist circumference, waist-to-height ratio, body fat, body fat percentage, fat mass index (FMI), appendicular skeletal muscle mass index (ASMI), total muscle mass, visceral fat area (VFA), systolic blood pressure, diastolic blood pressure, and metabolic indicators [fasting glucose, postprandial blood glucose at 2 hours, fasting insulin, postprandial insulin at 2 hours, homeostatic model assessment of insulin resistance (HOMA-IR), triglycerides, cholesterol, low-density lipoprotein cholesterol, uric acid, alanine aminotransferase, and aspartate aminotransferase] all showed significant reductions compared to pre-treatment levels (P<0.05). Before treatment, 114 patients were classified as the ASCVD low-risk group, while 58 patients were classified as the moderate-to-high-risk group. Compared with the moderate-high risk group, the low-risk group showed a decrease in fasting glucose, postprandial blood glucose at 2 hours, postprandial insulin at 2 hours, HOMA-IR, triglycerides, cholesterol, low-density lipoprotein cholesterol, alanine aminotransferase, and aspartate aminotransferase, while high-density lipoprotein cholesterol increased before treatment (P<0.05). Among the 58 patients with moderate-to-high ASCVD risk before treatment, 36 patients transitioned to low risk after 3 months of treatment (risk decreased subgroup), while 22 patients remained in the moderate-to-high-risk category (risk stable subgroup). After 3 months of treatment, the body weight, BMI, waist circumference, waist-to-height ratio, body fat, body fat percentage, FMI, VFA, fasting insulin, postprandial insulin at 2 hours, insulin resistance index, triglycerides, alanine aminotransferase, and aspartate aminotransferase all decreased compared to pre-treatment levels in both subgroups. The risk decreased subgroup also showed decreases in systolic blood pressure, diastolic blood pressure, fasting blood glucose, cholesterol, and low-density lipoprotein cholesterol (P<0.05). The reductions in BMI, body fat, body fat percentage, FMI, and VFA in the reduction subgroup were significantly greater than those in the risk stable subgroup (P<0.05). Multivariate Logistic regression analysis indicated that BMI (OR=1.257, 95%CI=1.034-1.528, P=0.022) was an independent risk factor influencing the reduction of risk factors in obese patients with moderate-to-high ASCVD risk. For every 1 unit decrease in BMI, the ASCVD risk decreased by 25.7%. After 3 months of treatment, the proportion of patients at moderate-to-high ASCVD risk decreased than before in the liraglutide group (n=51), metformin group (n=61), and untreated group (n=60) (P<0.05), with no significant differences in ASCVD risk levels or weight loss indicators among the three groups (P>0.05). In the group with 28.0 kg/m²≤BMI<32.5 kg/m² and the group with BMI≥32.5 kg/m², the proportion of patients at moderate-to-high ASCVD risk decreased after 3 months of treatment, with the 28.0 kg/m²≤BMI<32.5 kg/m² group showing a greater reduction in the proportion of patients at moderate-to-high ASCVD risk compared to the BMI≥32.5 kg/m² group (P<0.05). Both the female and male groups showed a decrease in the proportion of patients at moderate-to-high ASCVD risk after 3 months of treatment (P<0.05), with no significant differences in ASCVD risk levels between the two groups (P>0.05). Comparisons between the 18-30 years group and the ≥30 years group also showed no significant differences in ASCVD risk levels (P>0.05) .

Short-term medical weight loss in patients with obesity was benefit for effective weight loss and fat reduction, and improvement in ASCVD risk factors. However, for patients with a BMI ≥32.5 kg/m² and with moderate-high cardiovascular risk level, such weight loss measures are not sufficient to reduce the risk level of ASCVD in the short term, and stronger and durable weight loss measures are the treatment of choice for these patients in the future.

肥胖患者存在更多动脉粥样硬化性心血管疾病（ASCVD）风险，肥胖多学科门诊短期内科门诊减重对肥胖患者ASCVD风险等级的影响有待明确。

探讨短期内科门诊减重对肥胖患者ASCVD风险等级的影响。

回顾性选取2019年7月—2024年5月在南京鼓楼医院内分泌科肥胖多学科就诊并完成3个月随访的172例肥胖患者为研究对象。记录患者一般资料、临床指标及ASCVD风险（应用中国成年人ASCVD总体风险评估流程图进行ASCVD风险评估）。基于患者治疗前ASCVD风险评级分为中高危组（n=58）和低危组（n=114），比较两组一般资料的差异。中高危组患者根据治疗3个月后ASCVD风险下降情况分为中高危降低亚组（n=36）和中高危不变亚组（n=22），比较两亚组治疗前后各指标差异及ASCVD风险，采用多因素Logistic回归分析探究中高危ASCVD风险肥胖患者风险下降的影响因素。分析不同用药组及以BMI、性别、年龄分层的患者治疗3个月后ASCVD风险等级及减重指标的差异。

172例患者中男73例、女99例，平均年龄32（28，38）岁，平均体质量89.8（82.0，101.2）kg，平均BMI 31.6（30.0，33.9）kg/m²。治疗3个月后患者总体质量减少量为8.8%（5.6%，13.6%），BMI下降为28.8（27.0，30.7）kg/m²，腰围、腰高比、体脂肪、体脂百分比、脂肪质量指数（FMI）、四肢骨骼肌指数、总肌肉量、内脏脂肪面积（VFA）、收缩压、舒张压及糖脂代谢指标（空腹血糖、餐后2 h血糖、空腹胰岛素、餐后2 h胰岛素、胰岛素抵抗指数、三酰甘油、总胆固醇、低密度脂蛋白胆固醇、尿酸、丙氨酸氨基转移酶及天冬氨酸氨基转移酶）均较治疗前下降（P<0.05）。治疗前114例患者为ASCVD低危组，58例患者为ASCVD中高危组。与中高危组相比，低危组治疗前空腹血糖、餐后2 h血糖、餐后2 h胰岛素、胰岛素抵抗指数、三酰甘油、总胆固醇、低密度脂蛋白胆固醇、丙氨酸氨基转移酶及天冬氨酸氨基转移酶降低，高密度脂蛋白胆固醇升高（P<0.05）。58例治疗前中高危ASCVD风险患者治疗3个月后36例降为低风险（中高危降低亚组），22例患者仍为中高危（中高危不变亚组），治疗3个月后两亚组体质量、BMI、腰围、腰高比、体脂肪、体脂百分比、FMI、VFA、空腹胰岛素、餐后2 h胰岛素、胰岛素抵抗指数、三酰甘油、丙氨酸氨基转移酶及天冬氨酸氨基转移酶均较治疗前下降，中高危降低亚组收缩压、舒张压、空腹血糖、总胆固醇及低密度脂蛋白胆固醇较治疗前下降（P<0.05）；中高危降低亚组BMI、体脂肪、体脂百分比、FMI及VFA较中高危不变亚组下降（P<0.05）。多因素Logistic回归分析显示BMI（OR=1.257，95%CI=1.034~1.528，P=0.022）是中高危ASCVD风险肥胖患者危险因素下降的独立危险因素，BMI每下降1个单位，ASCVD风险降低25.7%。利拉鲁肽组（n=51）、二甲双胍组（n=61）及未用药组（n=60）治疗3个月后ASCVD中高危患者占比均较治疗前下降（P<0.05），治疗3个月后三组间ASCVD风险等级及减重指标比较，差异无统计学意义（P>0.05）。治疗3个月后28.0 kg/m²≤BMI<32.5 kg/m²组和BMI≥32.5 kg/m²组ASCVD中高风险患者占比均较治疗前下降，28.0 kg/m²≤BMI<32.5 kg/m²组ASCVD中高风险患者占比低于BMI≥32.5 kg/m²组（P<0.05）；治疗3个月后女性组和男性组ASCVD中高风险患者占比均下降（P<0.05），治疗3个月后两组ASCVD风险等级比较，差异无统计学意义（P>0.05）。治疗3个月后18~30岁组和≥30岁组ASCVD风险等级比较，差异无统计学意义（P>0.05）。

肥胖患者经短期内科门诊减重，可有效减重、减脂，改善ASCVD危险因素，对于BMI≥32.5 kg/m²伴中高危ASCVD风险者，这种减重措施尚不足以短期内降低ASCVD风险等级，更强及持久减重措施是未来治疗的选择。