Key result
An intensive lifestyle intervention emphasizing weight loss, physical activity, and an energy-reduced Mediterranean diet resulted in a 16% greater decrease in hsCRP and smaller increases in 3-NT and NT-proBNP compared to control over 5 years.
Why the study?
Lifestyles influence AF risk, but the effect of lifestyle interventions on circulating biomarkers characterizing the atrial substrate that facilitates AF development remained to be determined.
Does an intensive lifestyle intervention improve circulating biomarkers of atrial fibrillation-related pathways in adults with metabolic syndrome?
RCT (n=471)
Single-blind
1:1
Yes
Does an intensive lifestyle intervention improve circulating biomarkers of atrial fibrillation-related pathways in adults with metabolic syndrome?
An intensive lifestyle intervention emphasizing weight loss and a Mediterranean diet favorably modified biomarkers of inflammation, oxidative stress, and atrial stretch, suggesting a mechanism for lifestyle-mediated atrial fibrillation prevention.
Answers are grounded in this paper and cite their sources.
Supports lifestyle intervention for AF risk reduction in metabolic syndrome; extends RCT evidence on long-term biomarker pathway modulation.
Background Lifestyles influence atrial fibrillation (AF) risk. Blood biomarkers can characterize the atrial substrate that facilitates the development of AF. Therefore, determining the effect of lifestyle interventions on blood concentrations of biomarkers of AF-related pathways could help understand AF pathophysiology and contribute to AF prevention. Methods We studied 471 participants enrolled in the PREDIMED-Plus trial, a Spanish randomized trial conducted in adults (55-75 years) with metabolic syndrome and body mass index between 27-40 kg/m2. Eligible participants were randomized 1:1 to an intensive lifestyle intervention, emphasizing physical activity, weight loss, and adherence to an energy-reduced Mediterranean diet or to a control group. Serum biomarkers [carboxy-terminal propeptide of procollagen type I (PICP), high-sensitivity troponin T (hsTnT), high-sensitivity C reactive protein (hsCRP), 3-nitrotyrosine (3-NT), and N-terminal propeptide of B-type natriuretic peptide (NT-proBNP)] were measured at baseline, 3 and 5 years after randomization. Mixed models were used to evaluate the effect of intervention on changes in biomarkers through year 5. Mediation analysis was performed to examine the proportion mediated by each component of the intervention. Results At baseline, participants' mean age was 65, 41% were female, and 50% were assigned to the intervention. After five years, mean changes in log-transformed biomarkers were -0.03 (PICP), 0.19 (hsTnT), -0.15 (hsCRP), 0.12 (3-NT), and 0.30 (NT-proBNP). Compared to the control group, participants in the intervention group experienced greater decreases in hsCRP (-16%, 95% confidence interval (CI) -28%, -1%) or smaller increases in 3-NT (-15%, 95% CI -25%, -4%) and NT-proBNP (-13%, 95% CI -25%, 0%). The intervention had minimal impact on hsTnT (-3%, 95% CI -8%, 2%) or PICP concentrations (-0%, 95% CI -9%, 9%). The effect of the intervention on hsCRP was primarily mediated by weight loss (73% and 66% at years 3 and 5). Conclusion Over five years, a dietary and lifestyle intervention for weight-loss favorably affected concentrations of hsCRP, 3-NT, and NT-proBNP, pointing to specific mechanisms in pathways linking lifestyles and AF.
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Li et al. (2023) conducted an RCT in Metabolic syndrome (n=471). Intensive lifestyle intervention (energy-reduced Mediterranean diet, physical activity, weight loss) vs. Low-intensity dietary advice on a Mediterranean diet (ad libitum) was evaluated on Difference in percent change of high-sensitivity C reactive protein (hsCRP) concentration at 5 years (MD -16%, 95% CI -28%, -1%). An intensive lifestyle intervention emphasizing weight loss, physical activity, and an energy-reduced Mediterranean diet resulted in a 16% greater decrease in hsCRP and smaller increases in 3-NT and NT-proBNP compared to control over 5 years.
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