medwireNews: The risk for heart failure (HF) falls significantly with reductions in fat mass and waist circumference in overweight or obese people with type 2 diabetes, shows an analysis of data from the Look AHEAD trial.
Ambarish Pandey (University of Texas Southwestern Medical Center, Dallas, USA) and co-authors say that these anthropometric variables “may represent key, modifiable targets for lifestyle interventions” for the prevention of HF.
They report in Circulation that each 10% decrease in estimated fat mass over 1 year was associated with a significant 20% decrease in the risk for HF, after adjustment for demographics, treatment assignment, cardiorespiratory fitness, and cardiovascular risk factors.
Each 10% decrease in estimated waist circumference over 1 year was associated with a significant 23% decrease in HF risk, and similar associations were observed for 4-year changes in body composition and HF risk.
The analysis included 5103 overweight or obese Look AHEAD participants with type 2 diabetes who experienced 257 incident HF events during 12.4 years of follow-up. For the trial, the participants were randomly assigned to take part in an intensive lifestyle intervention program or a diabetes support and education program.
The researchers note that fat and lean mass measurements in the current analysis were predicted using validated equations, but the predictions showed good correlation (R2=0.87–0.90) with dual-energy X-ray absorptiometry measurements taken in a subgroup of 1369 participants.
In addition to an association with HF overall, the team found that each 10% decline in fat mass over 1 year was significantly associated with both types of HF, with a 22% lower risk for HF with preserved ejection fraction (HFpEF) and a 24% lower risk for HF with reduced ejection fraction (HFrEF).
By contrast, a 10% reduction in waist circumference over 1 year was associated with a significant 39% lower risk for HFpEF but there was no association with HFrEF.
There were no significant associations between the change in fat mass or waist circumference and the risk for myocardial infarction (MI), which occurred in 351 patients during follow-up, and there were no significant associations between changes in lean mass and either HF or MI risk.
Pandey and co-investigators conclude that “[f]uture studies are needed to determine if lifestyle interventions aimed at preferential reduction of [fat mass] or central adiposity may be effective in preventing HF, particularly HFpEF.”
They add: “This is particularly noteworthy because lifestyle-based weight loss interventions, such as those used in the Look AHEAD trial, led to mild reductions in [fat mass]” followed by regain “and thus may not be effective in lowering the risk of HF.”
The researchers note that “[i]n contrast, observational studies among patients undergoing bariatric surgery have demonstrated large declines in [fat mass] that may be durable.”
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Circulation 2020; doi:10.1161/CIRCULATIONAHA.120.050941