Effect of an Intensive Lifestyle Intervention on the Atrial Fibrillation Substrate

强化生活方式干预对心房颤动基质的影响

• 批准号: 10158273
• 负责人: Alvaro Alonso
• 金额: $ 75.8万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-05-15 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10158273
• 关键词: 3-nitrotyrosine; Adherence; Affect; Age; Ancillary Study; Anticoagulants; Arrhythmia; Atrial Fibrillation; Behavioral; Biological Markers; Blood; Body Weight; Body Weight decreased; Body mass index; Cardiac; Cardiac ablation; Cardiovascular Diseases; Cessation of life; Clinical; Cognitive; Data; Dementia; Development; Echocardiography; Etiology; Fat-Restricted Diet; Fibrosis; Functional disorder; Goals; Guidelines; Heart Atrium; Heart Diseases; Heart failure; Incidence; Individual; Inflammation; Intervention; Intervention Studies; Knowledge; Left; Left atrial structure; Life Style; Link; Maintenance; Measurement; Measures; Mediating; Mediation; Mediterranean Diet; Metabolic syndrome; Modification; Myocardial Infarction; Newly Diagnosed; Obesity; Observational Study; Olive oil preparation; Oral; Overweight; Oxidative Stress; Participant; Pathogenesis; Pathway interactions; Physical activity; Play; Predisposing Factor; Prevention; Primary Prevention; Process; Public Health; Public Policy; Randomized; Recommendation; Research Personnel; Risk; Risk Factors; Role; Spain; Stretching; Stroke; Structure; Time; Troponin; Weight Gain; Weight maintenance regimen; Woman; Work; adjudicate; base; cardiovascular disorder prevention; circulating biomarkers; coronary fibrosis; design; dietary; dietary control; effective intervention; experimental study; follow-up; high risk; improved; insight; intervention effect; intervention program; lifestyle intervention; meetings; men; mortality; myocardial damage; myocardial injury; obese person; prevent; primary endpoint; pro-brain natriuretic peptide (1-76); procollagen type I carboxy terminal peptide; randomized trial; recruit; secondary endpoint; stroke risk

PROJECT SUMMARY / ABSTRACT Atrial fibrillation (AF) is a common cardiac arrhythmia associated with an increased risk of stroke, heart failure, dementia, and mortality. Current treatments for AF, including antiarrhythmics, oral anticoagulants, and catheter ablation, have limited efficacy and carry significant risks, highlighting the need for prevention. Unfortunately, we currently lack effective interventions to prevent the onset of this common condition. Intervening on the cardiac substrate, characterized by atrial fibrosis and remodeling, to avert or reverse its development offers an attractive approach to AF prevention since this substrate is a key predisposing factor for AF onset. In our prior work in observational studies we have shown that increased body weight is a major risk factor for the development of AF. More recently, we also demonstrated in a randomized trial that individuals assigned to a Mediterranean diet enriched in extra-virgin olive oil had lower risk of AF than those assigned to a control diet. The pathophysiological mechanisms underlying the described associations are not completely understood, but changes in the atrial substrate are likely responsible. In this application, we propose to conduct an ancillary study to the recently-initiated PREDIMED-PLUS trial with the primary aim of assessing the effect of a weight-loss lifestyle intervention on the cardiac substrate of AF. The PREDIMED-PLUS study is a multi-center, randomized trial for the primary prevention of cardiovascular disease in 6,874 overweight and obese men and women with the metabolic syndrome in Spain. The trial will evaluate the effect of an intensive weight loss-focused lifestyle intervention program—including an energy-restricted Mediterranean diet, increased physical activity, and cognitive behavioral weight management—compared to a control intervention of low-intensity dietary advice on the Mediterranean diet. In the present application, we propose to conduct repeated assessments of the AF substrate performing repeated echocardiography and measurements of circulating biomarkers of pathways involved in the pathogenesis of the AF substrate (cardiac fibrosis, inflammation, oxidative stress, myocardial injury, atrial stretch) in 573 participants of the PREDIMED-PLUS trial with completed baseline echocardiographic exams. We will determine the effect of the intensive lifestyle intervention on cardiac structure and function, with a primary focus on the atria, and in biomarkers of AF-related pathways. Additionally, we will evaluate the association between the different components of the intervention (weight loss, compliance with the energy-restricted Mediterranean diet, increased physical activity) and changes in the atrial substrate. The proposed studies will determine the efficacy of an intensive lifestyle intervention on the pathophysiological substrate of AF and will inform the development of specific recommendations for the prevention of processes ending in the clinical onset of AF.

项目概要/摘要 心房颤动 (AF) 是一种常见的心律失常，与中风、心力衰竭、 痴呆症和死亡率。目前房颤的治疗方法，包括抗心律失常药、口服抗凝药和导管 消融的疗效有限，且风险很大，突出了预防的必要性。不幸的是，我们 目前缺乏有效的干预措施来预防这种常见病症的发生。对心脏进行干预 以心房纤维化和重塑为特征的基质，为避免或逆转其发展提供了一种方法 由于这种基质是 AF 发生的关键诱发因素，因此是预防 AF 的有吸引力的方法。在我们之前的 在观察性研究工作中，我们已经表明，体重增加是罹患糖尿病的一个主要危险因素。 房颤的发展。最近，我们还在一项随机试验中证明，个体被分配到 与对照组饮食相比，富含特级初榨橄榄油的地中海饮食患房颤的风险较低。 上述关联背后的病理生理机制尚不完全清楚，但是 心房基质的变化可能是造成这种情况的原因。 在此申请中，我们建议对最近启动的 PREDIMED-PLUS 试验进行辅助研究 主要目的是评估减肥生活方式干预对心脏基质的影响 AF。 PREDIMED-PLUS 研究是一项针对一级预防的多中心、随机试验 西班牙 6,874 名患有代谢综合征的超重和肥胖男性和女性患有心血管疾病。 该试验将评估以减肥为重点的强化生活方式干预计划的效果，其中包括 能量限制的地中海饮食、增加体力活动和认知行为权重 管理——与地中海饮食的低强度饮食建议的控制干预相比。在 在本申请中，我们建议对 AF 基板进行重复评估 超声心动图和参与发病机制的循环生物标志物的测量 第573章 573 PREDIMED-PLUS 试验的参与者已完成基线超声心动图检查。我们将 确定强化生活方式干预对心脏结构和功能的影响，主要包括 重点关注心房以及 AF 相关通路的生物标志物。此外，我们还将评估协会 干预措施的不同组成部分之间（减肥、遵守能量限制 地中海饮食、增加体力活动）和心房基质的变化。拟议的研究将 确定强化生活方式干预对 AF 病理生理基础的功效，并将 为制定预防临床结束过程的具体建议提供信息 房颤发作。

项目成果

Infant Metabolome in Relation to Prenatal DHA Supplementation and Maternal Single-Nucleotide Polymorphism rs174602: Secondary Analysis of a Randomized Controlled Trial in Mexico.

与产前 DHA 补充和母亲单核苷酸多态性 rs174602 相关的婴儿代谢组：墨西哥随机对照试验的二次分析。

• DOI: 10.1093/jn/nxab276
• 发表时间: 2021
• 期刊: The Journal of nutrition
• 作者: Tandon,Sonia;Gonzalez-Casanova,Ines;Barraza-Villarreal,Albino;Romieu,Isabelle;Demmelmair,Hans;Jones,DeanP;Koletzko,Berthold;Stein,AryehD;Ramakrishnan,Usha
• 通讯作者: Ramakrishnan,Usha

Lifestyles, Left Atrial Structure and Function, and Cognitive Decline in Adults with Metabolic Syndrome.

• DOI: 10.3390/jcm12186066
• 发表时间: 2023-09-20
• 期刊: Journal of clinical medicine
• 影响因子: 3.9

Lifestyles, left atrial structure and function, and cognitive decline in adults with the metabolic syndrome.

患有代谢综合征的成年人的生活方式、左心房结构和功能以及认知能力下降。

• DOI: 10.1101/2023.06.23.23291821
• 发表时间: 2023
• 期刊: medRxiv : the preprint server for health sciences
• 作者: Casanova,InesGonzalez;Alonso-Gómez,ÁngelM;Romaguera,Dora;Toledo,Estefanía;Li,Linzi;Fortuny,Elena;López,Luis;Ramallal,Raúl;Salas-Salvadó,Jordi;Tojal-Sierra,Lucas;Castañer,Olga;Alonso,Alvaro
• 通讯作者: Alonso,Alvaro

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

强化生活方式干预对代谢综合征患者心房颤动结构和功能基础的影响。

• DOI: 10.1101/2023.08.02.23293550
• 发表时间: 2023
• 期刊: medRxiv : the preprint server for health sciences
• 作者: Rossello,Xavier;Ramallal,Raúl;Romaguera,Dora;Alonso-Gómez,ÁngelM;Alonso,Alvaro;Tojal-Sierra,Lucas;Fernández-Palomeque,Carlos;Martínez-González,MiguelÁngel;Garrido-Uriarte,María;López,Luis;Díaz,Agnes;Zaldua-Irastorza,Olatz;Shah,A
• 通讯作者: Shah,A

Maternal FADS2 single nucleotide polymorphism modified the impact of prenatal docosahexaenoic acid (DHA) supplementation on child neurodevelopment at 5 years: Follow-up of a randomized clinical trial.

• DOI: 10.1016/j.clnu.2021.08.026
• 发表时间: 2021-10
• 期刊: CLINICAL NUTRITION
• 影响因子: 6.3
• 作者: Casanova, Ines Gonzalez;Schoen, Meriah;Tandon, Sonia;Stein, Aryeh D.;Villarreal, Albino Barraza;DiGirolamo, Ann M.;Demmelmair, Hans;Silva, Ivonne Ramirez;Feregrino, Raquel Garcia;Rzehak, Peter;Stevenson, India;Standl, Marie;Schnaas, Lourdes;Romieu, Isabelle;Koletzko, Berthold;Ramakrishnan, Usha
• 通讯作者: Ramakrishnan, Usha