Felicia R Simpson1, Nicholas M Pajewski2,3, Kristen M Beavers4, Stephen Kritchevsky5, Jeanne McCaffery6, Barbara J Nicklas5, Rena R Wing7, Alain Bertoni8, Frank Ingram1, Daniel Ojeranti1, Mark A Espeland2,5. 1. Department of Mathematics, Winston-Salem State University, North Carolina. 2. Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina. 3. Center for Health Care Innovation, Wake Forest School of Medicine, Winston-Salem, North Carolina. 4. Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina. 5. Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina. 6. Department of Allied Health Sciences, University of Connecticut, Storrs. 7. Centers for Behavioral and Preventive Medicine, The Miriam Hospital Medical School, Providence, Rhode Island. 8. Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Abstract
BACKGROUND: Individuals are often counseled to use behavioral weight loss strategies to reduce risk for cardiovascular disease (CVD). We examined whether any benefits for CVD risk from weight loss intervention extend uniformly to individuals across a range of underlying health states. METHODS: The time until first occurrence of a composite of fatal and nonfatal myocardial infarction and stroke, hospitalized angina, or CVD death was analyzed from 8 to 11 years of follow-up of 4,859 adults who were overweight or obese, aged 45-76 years with Type 2 diabetes. Individuals had been randomly assigned to either an intensive lifestyle intervention (ILI) or diabetes support and education (DSE). Participants were grouped by intervention assignment and a frailty index (FI) based on deficit accumulation, ordered from fewer (first tertile) to more (third tertile) deficits. RESULTS: Baseline FI scores were unrelated to intervention-induced weight losses and increased physical activity. The relative effectiveness of ILI on CVD incidence was inversely related to baseline FI in a graded fashion (p = .01), with relative benefit (hazard ratio = 0.73 [95% CI 0.55,0.98]) for individuals in the first FI tertile to no benefit (hazard ratio = 1.15 [0.94,1.42]) among those in the third FI tertile. This graded relationship was not seen for individuals ordered by age tertile (p = .52), and was stronger among participants aged 45-59 years (three-way interaction p = .04). CONCLUSIONS: In overweight/obese adults with diabetes, multidomain lifestyle interventions may be most effective in reducing CVD if administered before individuals have accrued many age-related health deficits. However, these exploratory analyses require confirmation by other studies. CLINICAL TRIAL REGISTRATION: NCT00017953.
BACKGROUND: Individuals are often counseled to use behavioral weight loss strategies to reduce risk for cardiovascular disease (CVD). We examined whether any benefits for CVD risk from weight loss intervention extend uniformly to individuals across a range of underlying health states. METHODS: The time until first occurrence of a composite of fatal and nonfatal myocardial infarction and stroke, hospitalized angina, or CVD death was analyzed from 8 to 11 years of follow-up of 4,859 adults who were overweight or obese, aged 45-76 years with Type 2 diabetes. Individuals had been randomly assigned to either an intensive lifestyle intervention (ILI) or diabetes support and education (DSE). Participants were grouped by intervention assignment and a frailty index (FI) based on deficit accumulation, ordered from fewer (first tertile) to more (third tertile) deficits. RESULTS: Baseline FI scores were unrelated to intervention-induced weight losses and increased physical activity. The relative effectiveness of ILI on CVD incidence was inversely related to baseline FI in a graded fashion (p = .01), with relative benefit (hazard ratio = 0.73 [95% CI 0.55,0.98]) for individuals in the first FI tertile to no benefit (hazard ratio = 1.15 [0.94,1.42]) among those in the third FI tertile. This graded relationship was not seen for individuals ordered by age tertile (p = .52), and was stronger among participants aged 45-59 years (three-way interaction p = .04). CONCLUSIONS: In overweight/obese adults with diabetes, multidomain lifestyle interventions may be most effective in reducing CVD if administered before individuals have accrued many age-related health deficits. However, these exploratory analyses require confirmation by other studies. CLINICAL TRIAL REGISTRATION: NCT00017953.
Authors: Lior Bibas; Michael Levi; Melissa Bendayan; Louis Mullie; Daniel E Forman; Jonathan Afilalo Journal: Prog Cardiovasc Dis Date: 2014-07-22 Impact factor: 8.194
Authors: Donna H Ryan; Mark A Espeland; Gary D Foster; Steven M Haffner; Van S Hubbard; Karen C Johnson; Steven E Kahn; William C Knowler; Susan Z Yanovski Journal: Control Clin Trials Date: 2003-10
Authors: M Bouchonville; R Armamento-Villareal; K Shah; N Napoli; D R Sinacore; C Qualls; D T Villareal Journal: Int J Obes (Lond) Date: 2013-07-04 Impact factor: 5.095
Authors: Mark A Espeland; W Jack Rejeski; Delia S West; George A Bray; Jeanne M Clark; Anne L Peters; Haiying Chen; Karen C Johnson; Edward S Horton; Helen P Hazuda Journal: J Am Geriatr Soc Date: 2013-05-13 Impact factor: 7.538
Authors: Samuel D Searle; Arnold Mitnitski; Evelyne A Gahbauer; Thomas M Gill; Kenneth Rockwood Journal: BMC Geriatr Date: 2008-09-30 Impact factor: 3.921
Authors: Mercedes Sotos-Prieto; Ellen A Struijk; Teresa T Fung; Eric B Rimm; Fernando Rodriguez-Artalejo; Walter C Willett; Frank B Hu; Esther Lopez-Garcia Journal: Age Ageing Date: 2022-02-02 Impact factor: 10.668
Authors: Mark A Espeland; Jamie Nicole Justice; Judy Bahnson; Joni K Evans; Medha Munshi; Kathleen M Hayden; Felicia R Simpson; Karen C Johnson; Craig Johnston; Stephen R Kritchevsky Journal: J Gerontol A Biol Sci Med Sci Date: 2022-08-12 Impact factor: 6.591
Authors: Felicia R Simpson; Owen Carmichael; Kathleen M Hayden; Christina E Hugenschmidt; Jeanne M McCaffery; Sevil Yasar; Nicholas M Pajewski; Mark A Espeland Journal: J Diabetes Complications Date: 2021-03-16 Impact factor: 3.219