WEIGHT LOSS IN OVERWEIGHT PATIENTS WITH CORONARY HEART DISEASE AND TYPE II DIAB

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The United States is currently experiencing an epidemic of obesity and type II diabetes. Over half of the general population is classified as overweight. In that being overweight is associated with a number of cardiac risk factors such as high cholesterol, high blood pressure and diabetes, overweight people are much more likely to develop coronary heart disease (CHD) than average-weight people. In fact 75-88% of people with recently diagnosed CHD are overweight and over 20% of these individuals have Type II diabetes. Cardiac Rehabilitation exercise programs for people with CHD have not been very effective in helping people lose weight through exercise-alone. We propose to study the effectiveness of: 1. A behaviorally-based weight loss program characterized by a daily calorie-intake goal and substantial behavioral and social support to attain dietary goals, and 2. An exercise program to assist with the weight loss intervention. The exercise program is characterized by almost daily exercise at the Cardiac Rehabilitation/ GCRC Exercise Testing and Training facility along with home-based walking. Outcome measures will include, body weight, fat mass and abdominal fat by CT scanning, measures of blood lipids, C-reactive protein, measures of clotting, vasodilatory capacity, glucose tolerance, echocardiographic cardiac function and an abdominal fat biopsy. Adipose tissue will be analyzed in Dr. Pratley's laboratory for gene expression levels of leptin, adiponectin, interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha ), macrophage chemotactic protein (MCP), macrophage inhibitory protein (MIP) and plasminogen activator-inhibitor-1 (PAI-1); all associated with adipose tissue, inflammation and thrombosis.