Association of Intensive Lifestyle Intervention, Fitness & BMI with Risk of Heart Failure in Overweight or Obese Adults with T2DM
‘Type 2 diabetes mellitus (T2DM) can be a risk factor for heart failure (HF). The association of body mass index (BMI) and lifestyle intervention and changes in cardiorespiratory fitness (CRF) as a risk factor for HF is not known. Pandey and colleagues published their analysis in American Heart Association Journal with title “Association of Intensive Lifestyle Intervention, Fitness and Body Mass Index with Risk of Heart Failure in Overweight or Obese Adults with Type 2 Diabetes Mellitus: An Analysis from the Look AHEAD Trial”. Summary of the analysis is provided below:
Objectives:
To study the impact of an intensive lifestyle intervention (ILI), fitness, and BMI on the risk of HF in overweight or obese adults with type 2 diabetes mellitus.
Method:
Look AHEAD (Action for Health in Diabetes) trial participants free from HF were included in the study. The risk of incident HF between diabetes support and education (DSE) vs. intensive lifestyle intervention (ILI) were compared by using the time to event analysis. By using multivariable-adjusted Cox models, the changes in risk of HF is evaluated by estimating changes in baseline CRF from the maximal treadmill test and BMI.
Findings:
As compare to DSE, the study reports no association between ILI in lowering the risk of HF and its subtypes. Inverse relation is found between CRF and the risk of HF. This relationship was independent of BMI and traditional risk factors. Constant improvement in CRF and weight loss for 4 years is found to be associated with a lower risk of incident HF. In middle age sedentary individuals, high-intensity exercise training for a prolonged period (2 years) may found to improve left ventricular (LV) stiffness and vice versa. The risk of developing HF, particularly HF with preserved ejection fraction (HFpEF) increases in T2DM patients with low CRF. This can be modified with improvement in CRF and weight reduction. Therapeutic strategies for weight loss such as bariatric surgery is reported to be associated with lowering HF risk.
Limitations:
In this secondary analysis there is a chance for unmeasured confounding and bias selection, investigators report. The study failed to establish a causal association in relation to CRF and the risk of incident HF. In the overall look AHEAD trial, important serum biomarkers were not measured. Findings can’t be generalized to unqualified look AHEAD trial participants due to the inability to participate in ILI.
