epidemiologic studies have found an association between obesity and atrial fibrillation (4-5% increased risk per each 1-unit inc in BMI), presumably mediated through the association of obesity with several factors which could predispose to atrial fibrillation, including diastolic dysfunction, a pro-inflammatory state, atrial enlargement, abnl autonomic function, and atrial structural and electrical remodeling. a randomized control trial was done in Australia to see if weight reduction would alter the course of atrial fibrillation\u00a0(doi:10.1001\/jama.2013.280521). 150 pts with BMI >27 (mean 33) randomized to intensive wt management (8 weeks of modified very low calorie diet of800-1200 kcal, followed by low glycemic index meals, along with written exercise plan of walking or cycling 45 min 3x\/wk) vs control (written and verbal nutrition and exercise advice, with fish oil 3g\/d) x 13 months. results (comparing intervention vs control):<\/p>\n
–wt loss of 14.3 vs 3.6 kg, waist circumf dec 17cm vs 5 cm, BMI dec 5.6 vs 1.3 units<\/p>\n
–biochem markers: hsCRP dec from 2.5 o 1.3 vs 2.3 to 1.9; chol changes not signif, but consistently better with intervention group (inc of HDL and dec in LDL)<\/p>\n
–BP: dec 3\/2 vs 1\/1 mm Hg (significant)<\/p>\n
–atrial fib assessment: atrial fib severity score (AFSS: scale of symptomatic afib frequency, duration and global assessment of severity, with range from 3.25 to 30) decreased 11.8 vs 2.6; 7-d ambulatory cardiac monitor found decrease in those with at least one episode of afib from 65% to 21% vs 57% to 56%, total number of episodes dec from 3.3 to 0.62 vs 2.8 to 2.0, total duration of afib from 1176 min to 491 vs 1394 to 1546 min.<\/p>\n
–echo showed dec in interventricular septal thickness of 1.1 vs 0.6mm and left atrial area of 3.5 to 1.9 cm2<\/p>\n
–of note the intervention group did have more people start metformin, lipid lowering drugs, BP drugs and had less alcohol consumption<\/p>\n
so, impressive data that this intervention led to dramatic decreases in atrial fib in overwt people with existing afib. \u00a0hard to disentangle what helped the most: wt loss or hypertension control or decreased drinking (or even perhaps using metformin: diabetes in recent study increased afib risk 50%, and in the current study those in the intervention group had similar blood sugars as the controls but significantly decreased insulin levels). \u00a0yet another study that lifestyle interventions help…<\/p>\n
geoff<\/p>\n","protected":false},"excerpt":{"rendered":"
atrial fib and weight reduction […]<\/p>\n