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
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.