medwireNews: A post-hoc analysis of the Look AHEAD trial suggests that weight loss can avert cardiovascular disease (CVD) events in overweight patients with Type 2 diabetes.
The initial Look AHEAD analysis comparing all patients who underwent intensive lifestyle modification with all controls found no significant difference in CVD event rates. But this combined analysis of 4834 patients irrespective of treatment assignation shows significantly reduced rates among patients who achieved at least a 10% weight reduction during the first year of the study, making it the first evidence of a protective effect in patients with established diabetes.
The 21% of patients who achieved this goal had a significant 21% reduction in the risk of the composite primary outcome of cardiovascular death, nonfatal acute myocardial infarction or stroke, or hospital admission for angina, relative to the 41% of patients whose weight increased or remained stable.
They also had a significant 24% reduction in risk of the secondary outcome, which additionally included coronary artery bypass grafting, carotid endarterectomy, percutaneous coronary intervention, hospitalisation for congestive heart failure, peripheral vascular disease and total mortality. The findings were adjusted for a range of variables including age, baseline weight, blood pressure and history of CVD.
Edward Gregg (US Centers for Disease Control and Prevention, Atlanta, Georgia, USA) and study co-authors also found some evidence of benefit for improved metabolic fitness. Patients who achieved at least a 2 metabolic equivalents improvement had a nonsignificant 22% reduction in risk of the primary outcome and a significant 23% reduction in risk of the secondary outcome.
The effect of significant weight loss remained when the team compared intervention patients who had lost weight with control participants. Each standard deviation increase in weight loss (about 7%) was associated with a 15% and 18% reduction in risk for the primary and secondary outcomes, respectively.
Intervention patients undertook individual and group sessions geared at reducing their calorie and fat intake and increasing their physical activity via behavioural approaches such as self-monitoring, goal setting and problem solving. The control group received only diabetes education and support.
In a commentary accompanying the study in The Lancet Diabetes & Endocrinology, Matti Uusitupa (University of Eastern Finland, Kuopio) says the findings provide “proof of concept for current recommendations”, albeit with cautions relating to the post-hoc analysis and marked obesity of the trial participants.
“However, in line with findings from previous studies in different populations, these results show that adherence to lifestyle changes is mandatory to achieve health benefits in the long term”, he says.
“To achieve any benefit from lifestyle changes, you have to change your lifestyle.”
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