Effect of an intensive lifestyle intervention on the structural and functional substrate for atrial fibrillation in people with metabolic syndrome.

Xavier Rossello, Raúl Ramallal, Dora Romaguera, Ángel M Alonso-Gómez, Alvaro Alonso, Lucas Tojal-Sierra, Carlos Fernández-Palomeque, Miguel Ángel Martínez-González, María Garrido-Uriarte, Luis López, Agnes Díaz, Olatz Zaldua-Irastorza, Amit J Shah, Jordi Salas-Salvadó, Montserrat Fitó, Estefania Toledo

Journal: European journal of preventive cardiology 2024;31(5):629-639

PMID: 38102071

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Plain Language Summary

Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia and a risk factor for stroke, heart failure, dementia, and mortality. AF is a progressive disease, with many patients advancing over time from subclinical states (changes in the atrial substrate) to clinical forms of the arrhythmia. The aim of this study was to evaluate the effect of an intensive lifestyle intervention (ILI) based on an energy-reduced Mediterranean diet (MedDiet), increased physical activity, and cognitive-behavioural weight management on the underlying structural and functional cardiac substrate of AF in overweight or obese people with metabolic syndrome (Mets). This study was an ancillary study of the PREDIMED-Plus trial. The trial was a multi-centre, randomised trial for the primary prevention of cardiovascular disease in overweight/obese individuals with Met. Participants were randomised 1:1 to an ILI programme based on an energy-reduced MedDiet, increased physical activity, and cognitive behavioural weight management or to a control intervention of low-intensity dietary advice on the MedDiet for at least 6 years. Results showed that an ILI programme based on an energy-reduced MedDiet, increased physical activity, and cognitive behavioural weight management did not show a significant impact on the structural and functional cardiac substrate of AF compared to the control intervention of low-intensity dietary advice on the MedDiet. Authors concluded that an ILI had no impact on the underlying structural and functional cardiac substrate of AF in overweight or obese people with Mets.

Abstract

AIMS

To evaluate the effect of an intensive lifestyle intervention (ILI) on the structural and functional cardiac substrate of atrial fibrillation (AF) in overweight or obese people with metabolic syndrome (Mets).

METHODS AND RESULTS

Participants of the PREvención con DIeta MEDiterranea-Plus trial (n = 6874) were randomized 1:1 to an ILI programme based on an energy-reduced Mediterranean diet, increased physical activity, and cognitive-behavioural weight management or to a control intervention of low-intensity dietary advice. A core echocardiography lab evaluated left atrial (LA) strain, function, and volumes in 534 participants at baseline, 3-year, and 5-year follow-ups. Mixed models were used to evaluate the effect of the ILI on LA structure and function. In the subsample, the baseline mean age was 65 years [standard deviation (SD) 5 years], and 40% of the participants were women. The mean weight change after 5 years was -3.9 kg (SD 5.3 kg) in the ILI group and -0.3 kg (SD 5.1 kg) in the control group. Over the 5-year period, both groups experienced a worsening of LA structure and function, with increases in LA volumes and stiffness index and decreases in LA longitudinal strain, LA function index, and LA emptying fraction over time. Changes in the ILI and control groups were not significantly different for any of the primary outcomes {LA emptying fraction: -0.95% [95% confidence interval (CI) -0.93, -0.98] in the control group, -0.97% [95% CI -0.94, -1.00] in the ILI group, Pbetween groups = 0.80; LA longitudinal strain: 0.82% [95% CI 0.79, 0.85] in the control group, 0.85% [95% CI 0.82, 0.89] in the ILI group, Pbetween groups = 0.24} or any of the secondary outcomes.

CONCLUSION

In overweight or obese people with Mets, an ILI had no impact on the underlying structural and functional LA substrate measurements associated with AF risk.

Address: Hospital Universitari Son Espases, Health Research Institute of the Balearic Islands (IdISBa), Carretera de Valldemossa, 79, 07120 Palma, Spain.; Cardiology Department, Hospital Universitari Son Espases, Palma, Spain.; Department of Cardiology, University Hospital of Navarra, Servicio Navarro de Salud Osasunbidea, IDISNA, Pamplona, Spain.; Hospital Universitari Son Espases, Health Research Institute of the Balearic Islands (IdISBa), Carretera de Valldemossa, 79, 07120 Palma, Spain.; CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute (ISCIII), C/Monforte de Lemos, 3-5, 28029 Madrid, Spain.; CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute (ISCIII), C/Monforte de Lemos, 3-5, 28029 Madrid, Spain.; Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain.; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.; CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute (ISCIII), C/Monforte de Lemos, 3-5, 28029 Madrid, Spain.; Department of Preventive Medicine and Public Health, University of Navarra, IdiSNA, Pamplona, Spain.; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.; Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain.; Cardiology Service, Hospital de Manacor, Manacor, Spain.; Cardiology Service, Clinica Universidad de Navarra, Pamplona, Spain.; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.; Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.; CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute (ISCIII), C/Monforte de Lemos, 3-5, 28029 Madrid, Spain.; Human Nutrition Unit, Department of Biochemistry and Biotechnology, Rovira i Virigili University, Reus, Spain.; CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute (ISCIII), C/Monforte de Lemos, 3-5, 28029 Madrid, Spain.; Cardiovascular and Nutrition Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.; CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute (ISCIII), C/Monforte de Lemos, 3-5, 28029 Madrid, Spain.; Department of Preventive Medicine and Public Health, University of Navarra, IdiSNA, Pamplona, Spain.

DOI: 10.1093/eurjpc/zwad380