强化生活方式干预、体适能与体重指数与 2 型糖尿病肥胖或超重患者心力衰竭风险的相关性：来自 LOOK AHEAD 试验的分析。
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.
机构信息
Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (A.P., K.V.P., D.K.M., J.D.B.).
Department of Biostatistics and Data Science (J.L.B., S.A.G.), Wake Forest School of Medicine, Winston-Salem, NC.
出版信息
Circulation. 2020 Apr 21;141(16):1295-1306. doi: 10.1161/CIRCULATIONAHA.119.044865. Epub 2020 Mar 5.
BACKGROUND
Type 2 diabetes mellitus (T2DM) is associated with a higher risk for heart failure (HF). The impact of a lifestyle intervention and changes in cardiorespiratory fitness (CRF) and body mass index on risk for HF is not well established.
METHODS
Participants from the Look AHEAD trial (Action for Health in Diabetes) without prevalent HF were included. Time-to-event analyses were used to compare the risk of incident HF between the intensive lifestyle intervention and diabetes support and education groups. The associations of baseline measures of CRF estimated from a maximal treadmill test, body mass index, and longitudinal changes in these parameters with risk of HF were evaluated with multivariable adjusted Cox models.
RESULTS
Among the 5109 trial participants, there was no significant difference in the risk of incident HF (n=257) between the intensive lifestyle intervention and the diabetes support and education groups (hazard ratio, 0.96 [95% CI, 0.75-1.23]) over a median follow-up of 12.4 years. In the most adjusted Cox models, the risk of HF was 39% and 62% lower among moderate fit (tertile 2: hazard ratio, 0.61 [95% CI, 0.44-0.83]) and high fit (tertile 3: hazard ratio, 0.38 [95% CI, 0.24-0.59]) groups, respectively (referent group: low fit, tertile 1). Among HF subtypes, after adjustment for traditional cardiovascular risk factors and interval incidence of myocardial infarction, baseline CRF was not significantly associated with risk of incident HF with reduced ejection fraction. In contrast, the risk of incident HF with preserved ejection fraction was 40% lower in the moderate fit group and 77% lower in the high fit group. Baseline body mass index also was not associated with risk of incident HF, HF with preserved ejection fraction, or HF with reduced ejection fraction after adjustment for CRF and traditional cardiovascular risk factors. Among participants with repeat CRF assessments (n=3902), improvements in CRF and weight loss over a 4-year follow-up were significantly associated with lower risk of HF (hazard ratio per 10% increase in CRF, 0.90 [95% CI, 0.82-0.99]; per 10% decrease in body mass index, 0.80 [95% CI, 0.69-0.94]).
CONCLUSIONS
Among participants with type 2 diabetes mellitus in the Look AHEAD trial, the intensive lifestyle intervention did not appear to modify the risk of HF. Higher baseline CRF and sustained improvements in CRF and weight loss were associated with lower risk of HF. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00017953.
背景
2 型糖尿病（T2DM）与心力衰竭（HF）风险增加相关。生活方式干预以及心肺适能（CRF）和体重指数的变化对 HF 风险的影响尚未得到充分证实。
方法
本研究纳入了来自 LOOK AHEAD 试验（糖尿病行动研究）中没有HF 既往史的参与者。采用时间事件分析比较强化生活方式干预组和糖尿病支持与教育组的 HF 事件发生率。使用多变量调整 Cox 模型评估最大跑步机测试估计的基线 CRF 水平、体重指数以及这些参数的纵向变化与 HF 风险的相关性。
结果
在 5109 名试验参与者中，在中位随访 12.4 年期间，强化生活方式干预组与糖尿病支持与教育组之间 HF 事件（n=257）的风险无显著差异（风险比，0.96[95%CI，0.75-1.23]）。在最调整的 Cox 模型中，中等适能（第 2 三分位数：风险比，0.61[95%CI，0.44-0.83]）和高适能（第 3 三分位数：风险比，0.38[95%CI，0.24-0.59]）组的 HF 风险分别降低 39%和 62%（参考组：低适能，第 1 三分位数）。在 HF 亚型中，在调整传统心血管危险因素和心肌梗死间隔发生率后，基线 CRF 与射血分数降低型 HF 的风险无显著相关性。相比之下，中等适能组射血分数保留型 HF 的风险降低 40%，高适能组降低 77%。调整 CRF 和传统心血管危险因素后，基线体重指数与射血分数降低型 HF、射血分数保留型 HF 或射血分数保留型 HF 之间也无相关性。在进行了重复 CRF 评估的参与者中（n=3902），4 年随访期间 CRF 改善和体重减轻与 HF 风险降低显著相关（每增加 10%的 CRF，风险比为 0.90[95%CI，0.82-0.99]；每降低 10%的体重指数，风险比为 0.80[95%CI，0.69-0.94]）。
结论
在 LOOK AHEAD 试验的 2 型糖尿病患者中，强化生活方式干预似乎并未改变 HF 的风险。基线 CRF 较高以及 CRF 和体重减轻的持续改善与 HF 风险降低相关。
Zotero 插件