PMID- 32134326 OWN - NLM STAT- MEDLINE DCOM- 20210401 LR - 20230303 IS - 1524-4539 (Electronic) IS - 0009-7322 (Print) IS - 0009-7322 (Linking) VI - 141 IP - 16 DP - 2020 Apr 21 TI - 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. PG - 1295-1306 LID - 10.1161/CIRCULATIONAHA.119.044865 [doi] AB - 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. FAU - Pandey, Ambarish AU - Pandey A AD - 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.). FAU - Patel, Kershaw V AU - Patel KV AD - 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.). FAU - Bahnson, Judy L AU - Bahnson JL AD - Department of Biostatistics and Data Science (J.L.B., S.A.G.), Wake Forest School of Medicine, Winston-Salem, NC. FAU - Gaussoin, Sarah A AU - Gaussoin SA AD - Department of Biostatistics and Data Science (J.L.B., S.A.G.), Wake Forest School of Medicine, Winston-Salem, NC. FAU - Martin, Corby K AU - Martin CK AD - Pennington Biomedical Research Center, Louisiana State University, Baton Rouge (C.K.M.). FAU - Balasubramanyam, Ashok AU - Balasubramanyam A AD - Section of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, Baylor College of Medicine, Houston, TX (A.B.). FAU - Johnson, Karen C AU - Johnson KC AD - Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.). FAU - McGuire, Darren K AU - McGuire DK AD - 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.). FAU - Bertoni, Alain G AU - Bertoni AG AD - Division of Public Health Sciences (A.G.B.), Wake Forest School of Medicine, Winston-Salem, NC. FAU - Kitzman, Dalane AU - Kitzman D AD - Department of Internal Medicine (D.K.), Wake Forest School of Medicine, Winston-Salem, NC. FAU - Berry, Jarett D AU - Berry JD AD - 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.). CN - Look AHEAD Research Group LA - eng SI - ClinicalTrials.gov/NCT00017953 GR - U01 DK057151/DK/NIDDK NIH HHS/United States GR - U01 DK057154/DK/NIDDK NIH HHS/United States GR - U01 DK056992/DK/NIDDK NIH HHS/United States GR - U01 DK057182/DK/NIDDK NIH HHS/United States GR - U01 DK057136/DK/NIDDK NIH HHS/United States GR - U01 DK057002/DK/NIDDK NIH HHS/United States GR - U01 DK057177/DK/NIDDK NIH HHS/United States GR - M01 RR001066/RR/NCRR NIH HHS/United States GR - U01 DK057078/DK/NIDDK NIH HHS/United States GR - U01 DK057008/DK/NIDDK NIH HHS/United States GR - U01 DK057149/DK/NIDDK NIH HHS/United States GR - M01 RR001346/RR/NCRR NIH HHS/United States GR - P30 DK048520/DK/NIDDK NIH HHS/United States GR - U01 DK057135/DK/NIDDK NIH HHS/United States GR - UL1 RR024153/RR/NCRR NIH HHS/United States GR - P30 DK072476/DK/NIDDK NIH HHS/United States GR - P30 DK046204/DK/NIDDK NIH HHS/United States GR - M01 RR002719/RR/NCRR NIH HHS/United States GR - M01 RR000056/RR/NCRR NIH HHS/United States GR - U01 DK057219/DK/NIDDK NIH HHS/United States GR - U01 DK057171/DK/NIDDK NIH HHS/United States GR - U54 GM104940/GM/NIGMS NIH HHS/United States GR - R03 AG067960/AG/NIA NIH HHS/United States GR - U01 DK057131/DK/NIDDK NIH HHS/United States GR - M01 RR000051/RR/NCRR NIH HHS/United States GR - T32 HL125247/HL/NHLBI NIH HHS/United States GR - U01 DK056990/DK/NIDDK NIH HHS/United States GR - UL1 RR025758/RR/NCRR NIH HHS/United States GR - U01 DK057178/DK/NIDDK NIH HHS/United States PT - Clinical Trial PT - Journal Article PT - Multicenter Study PT - Research Support, N.I.H., Extramural PT - Research Support, N.I.H., Intramural PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, Non-P.H.S. PT - Research Support, U.S. Gov't, P.H.S. DEP - 20200305 PL - United States TA - Circulation JT - Circulation JID - 0147763 SB - IM MH - Aged MH - *Body Mass Index MH - Diabetes Complications/epidemiology/pathology/physiopathology MH - *Diabetes Mellitus, Type 2/complications/epidemiology/pathology/physiopathology MH - Female MH - Follow-Up Studies MH - *Heart Failure/epidemiology/etiology/pathology/physiopathology MH - Humans MH - *Life Style MH - Male MH - Middle Aged MH - *Models, Cardiovascular MH - *Obesity/complications/epidemiology/pathology/physiopathology MH - Risk Factors PMC - PMC9976290 MID - NIHMS1577729 OTO - NOTNLM OT - body mass index OT - cardiorespiratory fitness OT - diabetes mellitus, type 2 OT - heart failure OT - obesity OT - overweight OT - risk EDAT- 2020/03/07 06:00 MHDA- 2021/04/02 06:00 PMCR- 2023/03/01 CRDT- 2020/03/06 06:00 PHST- 2020/03/07 06:00 [pubmed] PHST- 2021/04/02 06:00 [medline] PHST- 2020/03/06 06:00 [entrez] PHST- 2023/03/01 00:00 [pmc-release] AID - 10.1161/CIRCULATIONAHA.119.044865 [doi] PST - ppublish SO - Circulation. 2020 Apr 21;141(16):1295-1306. doi: 10.1161/CIRCULATIONAHA.119.044865. Epub 2020 Mar 5.