Effect of an Intensive Lifestyle Intervention on the Atrial Fibrillation Substrate

强化生活方式干预对心房颤动基质的影响

基本信息

批准号：
10088010
负责人：
Alvaro Alonso
金额：
$ 14.23万
依托单位：
EMORY UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-05-15 至 2022-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10088010
关键词：
3-nitrotyrosine Adherence Affect Age Ancillary Study Anticoagulants Arrhythmia Atrial Fibrillation Behavioral Biological Markers Blood Body Weight Body Weight decreased Body mass index Cardiac Cardiac ablation Cardiovascular Diseases Cessation of life Clinical Cognitive Data Dementia Development Diet Echocardiography Etiology Fat-Restricted Diet Fibrosis Functional disorder Goals Guidelines Heart Atrium Heart Diseases Heart failure Incidence Individual Inflammation Intervention Intervention Studies Knowledge Left Left atrial structure Life Style Link Maintenance Measurement Measures Mediating Mediation Mediterranean Diet Metabolic syndrome Modification Myocardial Infarction Newly Diagnosed Obesity Observational Study Olive oil preparation Oral Overweight Oxidative Stress Participant Pathogenesis Pathway interactions Physical activity Play Predisposing Factor Prevention Primary Prevention Process Public Health Public Policy Randomized Recommendation Research Personnel Risk Risk Factors Role Spain Stretching Stroke Structure Time Troponin Weight Gain Weight maintenance regimen Woman Work adjudicate base cardiovascular disorder prevention circulating biomarkers coronary fibrosis design effective intervention experimental study follow-up high risk improved insight intervention effect intervention program lifestyle intervention meetings men mortality myocardial damage myocardial injury prevent primary endpoint pro-brain natriuretic peptide (1-76)procollagen type I carboxy terminal peptide randomized trial recruit secondary endpoint stroke risk

项目摘要

PROJECT SUMMARY / ABSTRACT Atrial fibrillation (AF) is a common cardiac arrhythmia associated with an increased risk of stroke, heart failure, dementia, and mortality. Current treatments for AF, including antiarrhythmics, oral anticoagulants, and catheter ablation, have limited efficacy and carry significant risks, highlighting the need for prevention. Unfortunately, we currently lack effective interventions to prevent the onset of this common condition. Intervening on the cardiac substrate, characterized by atrial fibrosis and remodeling, to avert or reverse its development offers an attractive approach to AF prevention since this substrate is a key predisposing factor for AF onset. In our prior work in observational studies we have shown that increased body weight is a major risk factor for the development of AF. More recently, we also demonstrated in a randomized trial that individuals assigned to a Mediterranean diet enriched in extra-virgin olive oil had lower risk of AF than those assigned to a control diet. The pathophysiological mechanisms underlying the described associations are not completely understood, but changes in the atrial substrate are likely responsible. In this application, we propose to conduct an ancillary study to the recently-initiated PREDIMED-PLUS trial with the primary aim of assessing the effect of a weight-loss lifestyle intervention on the cardiac substrate of AF. The PREDIMED-PLUS study is a multi-center, randomized trial for the primary prevention of cardiovascular disease in 6,874 overweight and obese men and women with the metabolic syndrome in Spain. The trial will evaluate the effect of an intensive weight loss-focused lifestyle intervention program—including an energy-restricted Mediterranean diet, increased physical activity, and cognitive behavioral weight management—compared to a control intervention of low-intensity dietary advice on the Mediterranean diet. In the present application, we propose to conduct repeated assessments of the AF substrate performing repeated echocardiography and measurements of circulating biomarkers of pathways involved in the pathogenesis of the AF substrate (cardiac fibrosis, inflammation, oxidative stress, myocardial injury, atrial stretch) in 573 participants of the PREDIMED-PLUS trial with completed baseline echocardiographic exams. We will determine the effect of the intensive lifestyle intervention on cardiac structure and function, with a primary focus on the atria, and in biomarkers of AF-related pathways. Additionally, we will evaluate the association between the different components of the intervention (weight loss, compliance with the energy-restricted Mediterranean diet, increased physical activity) and changes in the atrial substrate. The proposed studies will determine the efficacy of an intensive lifestyle intervention on the pathophysiological substrate of AF and will inform the development of specific recommendations for the prevention of processes ending in the clinical onset of AF.

项目概要/摘要心房颤动 (AF) 是一种常见的心律失常，与中风、心力衰竭、目前治疗房颤的方法包括抗心律失常药、口服抗凝药和导管。消融的疗效有限且具有重大风险，不幸的是，我们强调预防的必要性。目前缺乏有效的干预措施来预防这种常见的心脏疾病的发生。以心房纤维化和重塑为特征的基质，为避免或逆转其发展提供了一种方法预防 AF 的有吸引力的方法，因为在我们之前的研究中，这种基质是 AF 发生的关键诱发因素。在观察性研究工作中，我们已经表明，体重增加是罹患糖尿病的一个主要危险因素。最近，我们还在一项随机试验中证明，个体被分配到一个组。与对照组饮食相比，富含特级初榨橄榄油的地中海饮食患房颤的风险较低。上述关联背后的病理生理机制尚不完全清楚，但是心房基质的变化可能是造成这种情况的原因。在此申请中，我们建议对最近启动的 PREDIMED-PLUS 试验进行辅助研究主要目的是评估减肥生活方式干预对心脏基质的影响 PREDIMED-PLUS 研究是一项针对 AF 一级预防的多中心、随机试验。西班牙 6,874 名患有代谢综合征的超重和肥胖男性和女性患有心血管疾病。该试验将评估以减肥为重点的强化生活方式干预计划的效果，其中包括能量限制的地中海饮食、增加体力活动和认知行为权重管理——与地中海饮食的低强度饮食建议的控制干预相比。在本申请中，我们建议对 AF 基板进行重复评估超声心动图和参与发病机制的通路测量的循环生物标志物第573章 573 PREDIMED-PLUS 试验的参与者已完成基线超声心动图检查。确定强化生活方式干预对心脏结构和功能的影响，主要包括重点关注心房以及 AF 相关通路的生物标志物。此外，我们将评估这种关联。干预措施的不同组成部分之间（减肥、遵守能量限制地中海饮食、增加体力活动）和心房基质的变化拟议的研究将。确定强化生活方式干预对 AF 病理生理基础的功效，并将告知制定具体建议，以预防临床结束的过程房颤发作。