medwireNews: People with type 2 diabetes and overweight or obesity who maintain weight loss and a high volume of physical activity (PA) significantly reduce their risk for cardiovascular death, myocardial infarction, stroke, or hospitalization for angina, suggests a post-hoc analysis of the Look AHEAD study published in JAMA Network Open.
In the original US multicenter randomized study of adults aged 55 years and older with type 2 diabetes and overweight or obesity (BMI≥25 kg/m2), the lifestyle intervention focused on weight loss did not reduce the incidence of cardiovascular events compared with diabetes support and education alone.
However, in this latest post-hoc analysis, which also measured weekly accelerometer-derived PA, investigators Xinxue Liao (First Affiliated Hospital, Guangzhou, China) and colleagues say that “maintaining weight loss and higher PA volume was associated with a lower risk of the composite cardiovascular outcome.”
They suggest that “weight loss may enhance the benefits from PA, and incorporating both might help in lowering the risk of cardiovascular events further.”
In all, 1229 individuals aged a mean of 60 years were assessed, 57% of whom were women. Weight loss of at least 7% was achieved and maintained by 333 (27%) individuals for the first 4 years, and of these, 105 (32%) also maintained a high PA volume of at least 175 min/week of moderate-to-vigorous PA (at least 10 consecutive min with intensity > 3 metabolic equivalent of tasks [METs]) at baseline, 1 year, and 4 years.
The risk for cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, or hospitalization for angina was significantly lower by 61% for the patients who maintained their weight loss and had high PA volume compared with 663 individuals whose weight loss was less than 7% and their PA volume low.
However, there was no reduction in cardiovascular risk for the 20.2% of individuals who only maintained weight loss or the 16.7% who only had high levels of PA.
The results also showed that a higher PA volume was linearly associated with cardiovascular risk reduction in individuals who lost weight, with the risk decreasing by 17% with 1000 MET minutes/week and 67% with 2000 MET minutes/week. By contrast, for individuals who did not lose weight, there was no cardiovascular benefit with increasing PA volume.
During weight loss, the cardiovascular benefits from increasing PA varied, which the researchers suggest may be due to differing individual characteristics at baseline.
Liao and co-authors comment that the findings “highlight the contribution of increasing PA to reduce the risk of cardiovascular events when implementing a weight loss program in those with [type 2 diabetes] and overweight or obesity.”
They propose that “weight loss may provide positive feedback for the benefits of increasing PA, and incorporating both may reverse the pathological changes of [type 2 diabetes] and obesity.”
In a linked editorial commenting on the findings, Lance Davidson (Brigham Young University, Provo, Utah, USA) says the analysis “reveals an important message for patients with diabetes.”
Davidson points out that “evidence from numerous trials indicates that individual responses to diet and exercise vary widely” but notes that one strength of Liao and colleagues’ study is that accelerometery was used to objectively measure PA.
He concludes that the “lifestyle message is compelling,” and it “emphasizes the synergistic role of weight loss maintenance and a physically active lifestyle: success in both is mandatory to achieve the desired cardiovascular benefit.”
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JAMA Netw Open 2024; 7: e240219
JAMA Netw Open 2024; 7: e240226