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LEGACY: Weight loss improves AF burden
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SAN DIEGO — New data from the LEGACY study suggest that long-term sustained weight loss may be an important strategy for reducing the increasing burden of atrial fibrillation.
Researchers evaluated 355 participants in a dedicated weight-loss clinic and tracked their health annually for an average of 4 years. All participants were obese (BMI ≥ 27 kg/m2) and had AF at baseline. To encourage weight loss, the clinic used a motivational, goal-directed approach that included three in-person visits per month, detailed dietary guidance, low-intensity exercise, support counseling, and maintenance of a daily diet and physical activity diary. Participants returned to the clinical annually for a health exam and AF monitoring, including questionnaires, Holter monitors for 7 days and echocardiograms.
“Previous studies have shown that weight management can reduce atrial fibrillation symptoms in the short term and improve outcomes of ablation [a surgical treatment for atrial fibrillation],” Rajeev K. Pathak, MD, a cardiologist and electrophysiology fellow at the University of Adelaide, Adelaide, Australia, said in a press release. “We sought to shed light on the long-term outcomes of sustained weight loss, the effects of the amount of weight lost and the impact of changes in weight over time.”
Participants were categorized by weight loss: > 10% of body weight (n = 135); 3% to 9% of body weight (n = 103) and < 3% (n = 117).
Freedom from symptoms of AF without antiarrhythmic drugs or ablation was 46% among participants with the greatest weight loss compared with 22% with moderate weight loss and 13% with the least weight loss (P < .001).
At the final follow-up, the rate of arrhythmia-free survival was 86% among participants with the greatest weight loss compared with 65.5% with moderate weight loss and 39.6% with the least weight loss (P < .001). In addition, the mean number of antiarrhythmic drugs was significantly lower among participants with the greatest weight loss (P < .001). The groups did not differ in the mean number of ablation procedures (P = .8).
“All three groups demonstrated some improvement in risk factors,” including BP, lipids, glycemic control and inflammation, Pathak said during a presentation. “The effect was significantly greater among those with 10% weight loss or more.”
Seventy-six percent of participants exhibited linear weight loss, while 59% demonstrated fluctuation in weight loss and 38% had a linear gain or were stable. The rate of freedom from AF was 85% among participants with less than 2% fluctuation in weight loss, compared with 59% with fluctuation of 2% to 5% and 44% with fluctuation of more than 5%.
“Patients with linear weight loss did well,” Pathak said.
According to multivariable analyses, weight loss of 10% or more was associated with AF-free survival (HR = 5.7; 95% CI, 3.3-10.1) and weight fluctuation of more than 5% was associated with AF recurrence (HR = 2.2; 95% CI, 1.1-4.2).
“Sustained weight loss is associated with a dose-dependent reduction in AF burden and maintenance of sinus rhythm,” Pathak concluded. “More than 5% weight fluctuation dampens the benefit conferred by weight loss. A dedicated clinic improves patient engagement, promoting treatment adherence [and] preventing weight regain and fluctuation.” – by Rob Volansky
References:
Pathak RK, et al. Late Breaker IV Session. Presented at: American College of Cardiology Scientific Sessions: March 14-16, 2015; San Diego.
Pathak RK, et al. J Am Coll Cardiol. 2015;doi:10.1016/j.jacc.2015.03.002.
Disclosure: Pathak reports no relevant financial disclosures.
Perspective
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Peter R. Kowey, MD
The data are very interesting and important, but we have had several examples in the past in which apparent benefit from lifestyle modifications were confounded by other immeasurable factors that played importantly into the observed clinical benefit. We are clearly going to need bigger and better controlled studies (not an easy thing to do in this realm) before we can conclude that weight loss per se is providing this benefit in terms of AF burden reduction. In the meantime, good clinicians should continue to advocate diet and exercise for all of our patients.
Perspective
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Prediman K. Shah, MD, FACC
If you are overweight and have AF, the first step should be to lose weight because you have a very good chance of staying free of AF. LEGACY was a remarkable study that confirmed what clinicians had suspected before — that obesity and its consequences are linked to AF. It should change the way doctors manage AF. If it doesn’t, I’ll be very disappointed, because this was a well-done study with very clear results. We can argue about the mechanisms, but the observation is real, and therefore I think weight loss should be a focus for patients with obesity and AF.
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