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: 10088010
• 负责人: Alvaro Alonso
• 金额: $ 14.23万
• 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 2022-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10088010
• 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; Diet; 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; effective intervention; experimental study; follow-up; high risk; improved; insight; intervention effect; intervention program; lifestyle intervention; meetings; men; mortality; myocardial damage; myocardial injury; 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.

项目摘要 /摘要 心房颤动（AF）是一种常见的心律不齐，与中风，心力衰竭，心力衰竭的风险增加有关 痴呆和死亡率。当前对AF的治疗方法，包括抗心律失常，口服抗凝剂和导管 消融，效率有限并承担重大风险，强调了预防的需求。不幸的是，我们 目前缺乏有效的干预措施来防止这种常见状况的发作。干预心脏 以房间纤维化和重塑为特征的底物为避免或逆转其发育提供了 有吸引力的AF预防方法，因为该底物是AF发作的关键诱发因素。在我们的先前 在观察性研究中，我们表明体重增加是 AF的开发。最近，我们还在一项随机试验中证明了分配给一个的个人 与对照饮食分配的橄榄油相比，富含电源橄榄油的地中海饮食的AF风险低。 所描述关联的基础的病理生理机制尚未完全理解，而是 心房基材的变化可能是负责的。 在此应用中，我们建议对最近发起的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板的影响 AF。 PERIMED-PLUS研究是一项多中心的，随机试验，用于主要预防 西班牙有代谢综合征的6,874次超重男性和女性的心血管疾病。 该试验将评估密集的以减肥生活方式干预计划的影响 - 包括 能源限制的地中海饮食，体育锻炼增加和认知行为体重 管理 - 与对地中海饮食的低强度饮食建议的控制干预有关。在 本应用，我们建议对AF底物的重复评估反复进行 超声心动图和与参与参与发病机理的循环生物标志物的测量 573中的AF底物（心脏纤维化，感染，氧化应激，心肌损伤，心房拉伸） Predimed-Plus试验的参与者，完成了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，主要是 专注于心房，以及与自动房屋相关途径的生物标志物。此外，我们将评估协会 在干预的不同组成部分之间（体重减轻，遵守能量限制 地中海饮食，增加体育锻炼）和心房底物的变化。拟议的研究将 确定对AF的病理生理底物的强化生活方式干预的效率 告知开发有关预防临床结尾的过程的具体建议 AF的发作。