Association of the magnitude of weight loss and changes in physical fitness with long-term cardiovascular disease outcomes in overweight or obese people with type 2 diabetes: a post-hoc analysis of the Look AHEAD randomised clinical trial.
Association of the magnitude of weight loss and changes in physical fitness with long-term cardiovascular disease outcomes in overweight or obese people with type 2 diabetes: a post-hoc analysis of the Look AHEAD randomised clinical trial.
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DOI：
10.1016/s2213-8587(16)30162-0
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发表时间：
2016-11
影响因子：
44.5
通讯作者：
Yanovski, Susan Z.
中科院分区：
文献类型：
--
作者：
Gregg, Edward W.;Jakicic, John M.;Lewis, Cora E.;Regensteiner, Judith G.;Pi-Sunyer, Xavier;Wing, Rena R.;Curtis, Jeffrey M.;Yanovski, Susan Z.;Evans, Mary;Lang, Wei;Neiberg, Rebecca H.;Ribisl, Paul M.;Gregg, Edward W.;Jakicic, John M.;Blackburn, George;Bloomquist, Paul;Bray, George A.;Clark, Jeanne M.;Coday, Mace;Curtis, Jeff Rey M.;Egan, Caitlin;Evans, Mary;Foreyt, John P.;Foster, Gary D.;Hazuda, Helen P.;Hill, James O.;Horton, Edward S.;Hubbard, Van S.;Ery, Robert W. Jeff;Johnson, Karen C.;Abbas;Kitabchi;Knowler, William C.;Kriska, Andrea;Lang, Wei;Lewis, Cora E.;Montez, Maria G.;Nathan, David M.;Neiberg, Rebecca H.;Patricio, Jennifer;Peters, Anne;Pi-Sunyer, Xavier;Pownall, Henry;Redmon, Bruce;Regensteiner, Judith G.;Rejeski, W. Jack;Ribisl, Paul M.;Ord, Monika Saff;Stewart, Kerry;Trence, Dace;Wadden, Thomas A.;Wing, Rena R.;Yanovski, Susan Z.
前瞻性研究发现，与随机接受糖尿病支持和教育(DSE)的人相比，参加强化减肥干预(ILI)的糖尿病成年人的心血管疾病(CVD)发病率没有显著降低。我们研究了未来心血管疾病的发生率是否会因体重或健康状况的变化而变化。在前瞻性研究中，在45-76岁患有2型糖尿病的超重或肥胖成年人中，这项观察性分析检查了第一年体重减轻幅度(N=4834)和健康变化(N=4406)与中位10.2年随访期心血管疾病发病率的关系。主要结果是心血管疾病死亡、心肌梗死、中风或心绞痛住院的综合结果；次要结果包括相同的指标加上冠状动脉搭桥术、颈动脉内膜切除术、经皮冠状动脉介入治疗、因充血性心力衰竭、外周血管疾病或总死亡率而住院。根据体重或健康、人口统计学和心血管疾病风险因素的基线差异进行调整的分析。在结合ILI和DSE的全队列分析中，第一年体重减轻10%的人与体重/体重稳定的人相比，主要结果的风险降低21%(HR=0.79，95%CI，0.64至0.98)，次要结果的风险降低24%(HR=0.76，95%CI，0.63至0.91)。达到MET 2适合度改变与二次结局的显著减少(HR=0.77，95%CI，0.61-0.96)相关，但与主要结局(HR=0.78，0.60-1.03)无关。在将DSE作为参照组的分析中，体重减轻10%的ILI参与者的主要结果风险降低20%(HR=0.80(95%CI，0.65-0.99)，次要结果风险降低21%(0.79(95%CI，0.66-0.95)；健身改变与这两种结果均无显著关联。这项对前瞻性的二次分析表明，有意减肥的程度与心血管疾病的发生率之间存在关联。
The Look AHEAD Study found no significant reduction in cardiovascular disease (CVD) incidence among adults with diabetes enrolled in an intensive weight loss intervention (ILI) compared to those randomized to diabetes support and education (DSE). We examined whether CVD incidence in Look AHEAD varied by weight or fitness change. Among overweight or obese adults people aged 45–76 with type 2 diabetes in the Look AHEAD study, this observational analysis examined the association of magnitude of weight loss (N=4834) and fitness change (N=4406) over the first year with CVD incidence over a median 10.2 years of follow-up. The primary outcome was a composite of CVD death, myocardial infarction, stroke, or angina hospitalization; the secondary outcome included the same indices plus coronary–artery bypass grafting, carotid endartectomy, percutaneous coronary intervention, hospitalization for congestive heart failure, peripheral vascular disease, or total mortality. Analyses adjusted for baseline differences in weight or fitness, demographics and CVD risk factors. In analyses of the full cohort combining ILI and DSE, persons who lost > 10% body weight in the first year had 21% lower risk of the primary outcome (HR=0.79, 95% CI, 0.64 to 0.98) and a 24% reduced risk of the secondary outcome (HR=0.76, 95% CI, 0.63 to 0.91) relative to those with stable weight/weight gain. Achieving a > 2 MET fitness change was associated with a significant reduction in the secondary outcome (HR=0.77, 95% CI, 0.61 – 0.96) but not the primary outcome (HR=0.78, 0.60 – 1.03). In analyses treating the DSE as the referent group, ILI participants with > 10% weight losses had a 20% lower risk of the primary outcome (HR=0.80 (95% CI, 0.65 – 0.99) and a 21% reduced risk of the secondary outcome (0.79 (95% CI, 0.66 – 0.95); fitness change was not significantly associated with either outcome. This secondary analysis of Look AHEAD suggests an association between the magnitude of intentional weight loss and CVD incidence.