David Cohen, M.D.·Published 1 July 2013·8 min read
Key points
An intensive lifestyle intervention focusing on weight loss did not reduce the rate of cardiovascular events in overweight or obese adults with type 2 diabetes, according to final results of the randomized controlled Look AHEAD trial.
Coronary heart disease (CHD) is the single most common cause of death in the UK†.
Rena Wing, PhD, of Brown University, and colleagues reported their findings simultaneously online in the New England Journal of Medicine and at the American Diabetes Association meeting here.
Nonetheless, people in the intervention group benefited in terms of a host of other ways, Mary Evans, PhD, director of Look AHEAD at the National Institute of Diabetes and Digestive and Kidney Diseases, told The Gupta Guide.
An intensive lifestyle intervention focusing on weight loss did not reduce the rate of cardiovascular events in overweight or obese adults with type 2 diabetes, according to final results of the randomized controlled Look AHEAD trial.
The study was halted in September on the basis of a futility analysis that showed no significant differences in the composite primary outcome of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for angina between those who had the intervention and those who only received support: 1.83 versus 1.92 events per 100 person-years, respectively (P=0.51).
Rena Wing, PhD, of Brown University, and colleagues reported their findings simultaneously online in the New England Journal of Medicine and at the American Diabetes Association meeting here.
Nonetheless, people in the intervention group benefited in terms of a host of other ways, Mary Evans, PhD, director of Look AHEAD at the National Institute of Diabetes and Digestive and Kidney Diseases, told The Gupta Guide.
"They sustained 6% weight loss over 10 years. They had clinically meaningful improvements in glycated hemoglobin levels and less diabetes and less retinopathy. There were also improvements in quality of life and reduction in depression," she said.
Coronary Heart Disease
Coronary heart disease (CHD) is the single most common cause of death in the UK†. CHD is caused by atherosclerosis - the furring up and narrowing of the small arteries that supply blood to the heart. When the flow of blood to the heart is restricted this causes pain - "angina". If a blood clot forms within the narrowed arteries it can block the flow of blood to the heart and cause a heart attack. Obesity and Heart Disease
The risk of CHD is increased by an unhealthy diet, high cholesterol levels (mainly caused by too much fat in the diet) and obesity (particularly where excess weight is stored around the waist). Being overweight can also contribute to high blood pressure (hypertension) which increases your risk of CHD. Losing Weight Good for Your Heart
Losing weight / maintaining a healthy weight will help protect you from heart disease. Research has also shown that many overweight people with angina, raised blood cholesterol and high blood pressure found their conditions improved even after losing just some of their excess weight. Benefits of Healthy Balanced Diet
It is estimated that up to 30% of deaths from CHD are due to unhealthy diets†. Eating a healthy balanced diet will help look after your heart. Aim to:
Increase your fruit and vegetable intake. Reduce your fat intake.Following the Weight Loss Resources' recommended nutrition profile - 55% carbs; 15% protein; 30% fat - will ensure your body gets the right amount of vitamins and minerals and energy levels to keep everything in working order.
Written and revised by
David Cohen, M.D.
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Increase your intake of wholegrain foods, such as breads, cereals, rice.
Reduce your salt intake.
Increase your intake of oily fish.
Evans said explanations for the lack of benefit among people in the intervention group include greater use of medications in the control group. "The drugs, particularly statins, could have lowered their risk of cardiovascular disease.
"Or perhaps people in the intervention group didn't achieve enough weight loss," she said.
Ramp up your home cooking with these nutrient-packed dishes the next time your tummy - or your heart - needs a boost
When you're the chef, the power to eat healthy is in your hands.
"The more that people eat at home and prepare their own meals, the better they do at losing weight or maintaining a healthy weight," which decreases your risk of heart attack and stroke, says Judith Wylie-Rosett, Ed.D., R.D., a spokesperson for the American Heart Association.
That's because restaurant meals tend to include few vegetables and contain high amounts of calories, artery-clogging fat, and blood-pressure-elevating sodium.
The Look AHEAD (Action for Health in Diabetes) trial enrolled 5,145 overweight or obese patients with type 2 diabetes at 16 centers in the U.S.
Patients were randomized to either an intensive lifestyle intervention that focused on cutting calories and increasing physical activity or to a control group that only received diabetes support and education.
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When the trial was stopped in September 2012, the median follow-up time was 9.6 years.
According to Ralph Gonzales and Paul L. Nadler in "Current Medical Diagnosis and Treatment," weight loss that is unintentional and is more than 5 percent of a person's total body weight, occurring over at least six months, is medically concerning. Weight loss may result from a number of disease processes, the most concerning of which is cancer. However, other causes of weight loss include gastrointestinal disease, infection and psychiatric illnesses, such as depression or dementia.
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The weight-heart connection is simple: Weight loss is an important shield against coronary heart disease. If there is heart disease in your family, or you're on prescriptions for blood pressure, or your doctor warns you about extra heart risks ... you may feel a bit like disease is your destiny.
But take heart. In its Guidelines for the Treatment of Overweight and Obesity, The National Institutes of Health report that a 5 to 10 percent weight loss can make a huge difference.
But first, find out what losing weight can do for you. It will:
Put a stop to scary numbers. "Obese people frequently have abnormal blood-cholesterol levels, higher blood pressure, and even sometimes bigger hearts," says Dr. Gerald Fletcher, a cardiologist at the Mayo Clinic in Jacksonville, Florida, and a spokesperson for the American Heart Association. All of these things are risk factors for heart disease, but losing weight can help you reverse them.
Do double duty. Overweight and obesity are independently linked to heart disease, too. "Until a few years ago, it was thought to be an indirect link (for example, weight causes cholesterol, cholesterol causes heart disease), but now we know that even if blood pressure and cholesterol are normal, extra weight can mean extra risk for heart disease," says Karen Miller-Kovach, Weight Watchers chief scientist. So when you lose weight, often what you end up getting are double and triple benefits - you'll lower your blood pressure and cholesterol, and you'll conquer a primary risk factor for heart disease.
Work over time. You don't have to wait for your weight goal to see a difference in your heart health. "When it comes to heart disease and weight, there's an exponential curve," says Miller-Kovach. "A little bit of extra weight increases your risk for heart disease a little bit, and vice versa." In the same way, a little bit of weight loss decreases your risk a little bit, and vice versa again.
Add exercise to the equation. As you're losing weight, you're more likely to start exercising, which has bonuses of its own: "Exercise has been recognized as an independent positive factor to heart health," says Miller-Kovach. "We now know that exercise tends to mobilize the fat stores in the abdomen, which are the ones that put you at the greatest risk for heart disease." Plus, says Fletcher, in addition to preserving "good" cholesterol, exercise will help you control your blood pressure, among other things.
Help no matter what your age ... "Age factors into [the weight-heart connection] prominently," says Miller-Kovach. "Being slightly obese at a younger age causes a greater increase in risk of heart disease than does being slightly obese and elderly." In other words: It's not just how much weight you have, it's how old you are. So you might reconsider the idea that there's no reason to worry about your heart until you're older.
... And no matter who you are. Weight loss will improve the heart health of both men and women. It will also make a difference even if you're African American, Hispanic or Native American, populations that are said to be at a higher risk for blood pressure, obesity and diabetes.
Weight loss was greater in the intervention group than in the control group throughout the study (8.6% versus 0.7% at 1 year; 6.0% versus 3.5% at study end).
The intense lifestyle change also produced greater initial improvements in fitness and cardiovascular risk factors, except for LDL cholesterol. But the between-group differences diminished over time.
As for adverse events, the rate of self-reported fractures was significantly higher in the intervention group: 2.51 versus 2.16 per 100 person-years in the control group (P=0.01). However, there was no significant difference in the rate of adjudicated fractures (1.66 and 1.64 per 100 person-years, respectively).
A limitation of the study is that patients who were motivated to lose weight were recruited, so the findings may not generalize to all patients, the researchers said.
In an accompanying editorial, Hertzel Gerstein, MD, of the McMaster University, wrote, "Even with no clear evidence of cardiovascular benefit, the Look AHEAD investigators have shown that attention to activity and diet can safely reduce the burden of diabetes and have reaffirmed the importance of lifestyle approaches as one of the foundations of modern diabetes care."
Will you continue to try to motivate overweight and obese patients with diabetes to lose weight? Add Your Knowledge below. -- Sanjay Gupta, MD
The study was supported by the NIH. Additional support was provided by several universities and by FedEx, Health Management Resources, Johnson & Johnson, Nestle HealthCare Nutrition, Hoffman-La Roche, Abbott Nutrition, and Unilever North America.
The researchers reported relationships with Vivus, Eisai, Arena, Orexigen, Takeda, Novo Nordisk, Amylin/Lilly, BD, Abbott Diabetes Care, Janssen, Medtronic, Roche, Sanofi, Dainippon, Perrigo, Boehringer Ingelheim, Kowa, Medifast, Global Direction in Medicine, Herbalife, Allere Wellbeing, BodyMedia, JennyCraig, Nestle Nutrition Institute, JDRF, diaDexus, Amgen, Weight Watchers, and Nutrisystem.
The editorialists reported relationships with Sanofi, Lilly, Roche, Novartis, AstraZeneca, Bristol-Myers Squibb, Bayer, Novo Nordisk, Boehringer Ingelheim, and Merck.
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Primary source: New England Journal of Medicine Source reference: Wing R, et al "Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes" N Engl J Med 2013; DOI: 10.1056/NEJMoa1212914.
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