AIMS: Prevention guidelines have identified the management of obese patients as an important priority to reduce the burden of incident and recurrent cardiovascular disease. Still, studies have demonstrated that over 80% of patients with coronary heart disease (CHD) fail to achieve their weight target. Here, we describe advice received and actions reported by overweight CHD patients since being discharged from hospital and how weight changes relate to their risk profile. METHODS AND RESULTS: Based on data from 10 507 CHD patients participating in the EUROASPIRE IV and V studies, we analysed weight changes from hospital admission to the time of a study visit ≥6 and <24 months later. At hospitalization, 34.9% were obese and another 46.0% were overweight. Obesity was more frequent in women and associated with more comorbidities. By the time of the study visit, 19.5% of obese patients had lost ≥5% of weight. However, in 16.4% weight had increased ≥5%. Weight gain in those overweight was associated with physical inactivity, non-adherence to dietary recommendations, smoking cessation, raised blood pressure, dyslipidaemia, dysglycaemia, and lower levels of quality of life. Less than half of obese patients was considering weight loss in the coming month. CONCLUSIONS: The management of obesity remains a challenge in the secondary prevention of CHD despite a beneficial effect of weight loss on risk factor prevalences and quality of life. Cardiac rehabilitation programmes should include weight loss interventions as a specific component and the incremental value of telehealth intervention as well as recently described pharmacological interventions need full consideration.

Cardiology Department Singidunum University School of Medicine Clinic for Internal Disease Intermedica Jovana Ristica str 20 2 18000 Nis Serbia

Cardiovascular Medicine Department Assiut University Heart Hospital Assiut University Assiut University Campus 71515 Assiut Egypt

Centre for Cardiovascular Prevention 1st Faculty of Medicine and Thomayer Hospital Charles University Videnska 800 Prague 4 140 59 Czech Republic

Department of Cardiology and Internal Diseases Kyrgyz State Medical Academy Akhunbaev str 92 720020 Bishkek Kyrgyzstan

Department of Cardiology Interventional Electrocardiology and Hypertension Jagiellonian University Medical College 2 Jakubowski Str 30 688 Kraków Poland

Department of Internal Medicine Lapland Central Hospital Ounasrinteentie 22 96400 Rovaniemi Finland

Department of Medicine Solna Karolinska Institutet FoU Tema Hjärta och Kärl S1 02 Karolinska Universitetssjukhuset Solna SE 171 76 Stockholm Sweden

Department of Public Health and Primary Care Ghent University C Heymanslaan 10 6K3 entrance 42 B 9000 Ghent Belgium

Department of Vascular Medicine Division of Medicine University Medical Centre Ljubljana Zaloška 7 SI 1525 Ljubljana Slovenia

Imperial College Healthcare NHS Trust Praed Street London W2 1NY UK

Medical Faculty University of Ljubljana Vrazov trg 2 1000 Ljubljana Slovenia

National Centre of Cardiology and Internal Medicine Named After Academician Mirrakhimov MM Togolok Moldo str 3 720040 Bishkek Kyrgyzstan

National Heart and Lung Institute Imperial College London Guy Scadding Building Dovehouse St London SW3 6LY UK

National Heart Hospital Department of Cardiology Konjovitza str 65 1309 Sofia Bulgaria

National Institute for Prevention and Cardiovascular Health National University of Ireland Galway Croí Heart and Stroke Centre Croí House Moyola Lane Newcastle Galway H91 FF68 Ireland

National Medical Research Centre of Cardiology of the Ministry of Healthcare of the Russian Federation 3 rd Cherepkovskaya str 15A 121552 Moscow Russia

Shupyk National Medical Academy of Postgraduate Education Dorohozhytska 9 04112 Kyiv Ukraine

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