History of cardiovascular disease, intensive lifestyle intervention, and cardiovascular outcomes in the Look AHEAD Trial

Details

• Alternative Title:
  Obesity (Silver Spring)
• Personal Author:
  Lewis, Cora E. ; Bantle, John P. ; Bertoni, Alain G. ; Blackburn, George ; Brancati, Frederick L. ; Bray, George A. ; Cheskin, Lawrence J. ; Curtis, Jeffrey M. ; Egan, Caitlin ; Evans, Mary ; Foreyt, John P. ; Ghazarian, Siran ; Gibbs, Bethany Barone ; Glasser, Stephen ; Gregg, Edward W. ; Hazuda, Helen P. ; Hesson, Louise ; Hill, James O. ; Horton, Edward S. ; Hubbard, Van S. ; Jakicic, John M. ; Jeffery, Robert W. ; Johnson, Karen C. ; Kahn, Steven E. ; Kitabchi, Abbas E. ; Kitzman, Dalane ; Knowler, William C. ; Lipkin, Edward ; Michaels, Sara ; Montez, Maria G. ; Nathan, David M. ; Nyenwe, Ebenezer ; Patricio, Jennifer ; Peters, Anne ; Pi-Sunyer, Xavier ; Pownall, Henry ; Reboussin, David ; Ryan, Donna H. ; Wadden, Thomas A. ; Wagenknecht, Lynne E. ; Wyatt, Holly ; Wing, Rena R. ; Yanovski, Susan Z.
• Corporate Authors:
  Look AHEAD Research Group
• Description:
  OBJECTIVE-
  
  To examine intensive lifestyle intervention (ILI) effects on cardiovascular disease (CVD), Look AHEAD randomized 5145 participants with Type 2 diabetes and overweight/obesity to ILI or Diabetes Support and Education (DSE). While the primary outcome did not differ, there was suggestive evidence of heterogeneity for pre-specified baseline CVD history subgroups (interaction p=0.063). Event rates were higher in ILI among those with CVD history (hazard ratio [HR] 1.13 [95% CI 0.90-1.41]) and lower without CVD (HR, 0.86 [95% CI 0.72-1.02]).
  
  METHODS-
  
  Post-hoc analyses of rates of primary composite outcome and components: adjudicated cardiovascular death, nonfatal myocardial infarction (MI), stroke, and hospitalization for angina; and three secondary composite outcomes.
  
  RESULTS-
  
  Interaction p values for the primary and two secondary composites were similar (0.060-0.064). Of components, the interaction was significant for non-fatal MI (p=0.035). This interaction was not due to confounding by baseline variables, different intervention responses for weight-loss and physical fitness, or hypoglycemic events. In those with CVD history, statin use was high and similar by group. In those without, LDL-C levels were higher (p=0.003) and statin use lower (p=<0.001) in ILI.
  
  CONCLUSIONS:
  
  Intervention response heterogeneity was significant for non-fatal MI. Response heterogeneity may need consideration in CVD outcome trial design.
  
  
• Subjects:
  Cardiovascular Diseases Female Humans Life Style Male Middle Aged
• Keywords:
  Buprenorphine Diabetes Diabetes, Type 2 Lifestyle Lipids And Cholesterol Look AHEAD (Action For Health In Diabetes) Methadone Mortality Myocardial Infarction Naltrexone Obesity Outcome Risk Factors Treatment

  More +
• Source:
  Obesity (Silver Spring). 28(2):247-258
• Pubmed ID:
  31898874
• Pubmed Central ID:
  PMC6980987
• Document Type:
  Journal Article
• Funding:
  P30 AG024827/AG/NIA NIH HHSUnited States/ ; U01 DK057151/DK/NIDDK NIH HHSUnited States/ ; U01 DK057154/DK/NIDDK NIH HHSUnited States/ ; U01 DK056992/DK/NIDDK NIH HHSUnited States/ ; U01 DK057171/DK/NIDDK NIH HHSUnited States/ ; P30 DK079637/DK/NIDDK NIH HHSUnited States/ ; P30 DK079626/DK/NIDDK NIH HHSUnited States/ ; U01 DK057136/DK/NIDDK NIH HHSUnited States/ ; U01 DK057002/DK/NIDDK NIH HHSUnited States/ ; M01 RR000211/RR/NCRR NIH HHSUnited States/ ; U01 DK057177/DK/NIDDK NIH HHSUnited States/ ; M01 RR001066/RR/NCRR NIH HHSUnited States/ ; U01 DK057078/DK/NIDDK NIH HHSUnited States/ ; M01 RR000043/RR/NCRR NIH HHSUnited States/ ; P30 DK056336/DK/NIDDK NIH HHSUnited States/ ; U01 DK057008/DK/NIDDK NIH HHSUnited States/ ; U01 DK057149/DK/NIDDK NIH HHSUnited States/ ; P30 DK048520/DK/NIDDK NIH HHSUnited States/ ; U01 DK057135/DK/NIDDK NIH HHSUnited States/ ; UL1 RR024153/RR/NCRR NIH HHSUnited States/ ; P30 DK046204/DK/NIDDK NIH HHSUnited States/ ; NR/NINR NIH HHSUnited States/ ; M01 RR002719/RR/NCRR NIH HHSUnited States/ ; M01 RR000056/RR/NCRR NIH HHSUnited States/ ; U01 DK057219/DK/NIDDK NIH HHSUnited States/ ; U01 AG073697/AG/NIA NIH HHSUnited States/ ; U01 DK057182/DK/NIDDK NIH HHSUnited States/ ; U01 DK057131/DK/NIDDK NIH HHSUnited States/ ; M01 RR000051/RR/NCRR NIH HHSUnited States/ ; U01 DK056990/DK/NIDDK NIH HHSUnited States/ ; UL1 RR025758/RR/NCRR NIH HHSUnited States/ ; U01 DK057178/DK/NIDDK NIH HHSUnited States/ ; M01 RR001346/RR/NCRR NIH HHSUnited States/ ; P30 DK017047/DK/NIDDK NIH HHSUnited States/ ; CC/CDC HHSUnited States/
• Volume:
  28
• Issue:
  2
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:83731220694f3110584979241508c597a696e9661decbd5da7391da9bbb67168dd6fec93de28e911587a2f61d0ddf178bae66dab326d12c8717c006ea3ae23d3
• Download URL:
  https://stacks.cdc.gov/view/cdc/84517/cdc_84517_DS1.pdf
• File Type:
  [PDF - 486.00 KB ]