Association of Baseline and Longitudinal Changes in Body Composition Measures With Risk of Heart Failure and Myocardial Infarction in Type 2 Diabetes: Findings From the Look AHEAD Trial
Open accessAbstract
Background: Intentional weight loss is associated with lower risk of heart failure (HF) and atherosclerotic cardiovascular disease among patients with type 2 diabetes. However, the contribution of baseline measures and longitudinal changes in fat mass (FM), lean mass (LM), and waist circumference (WC) to the risk of HF and myocardial infarction (MI) in type 2 diabetes is not well established. Methods: Adults from the Look AHEAD trial (Action for Health in Diabetes) without prevalent HF were included. FM and LM were predicted using validated equations and compared with dual-energy x-ray absorptiometry measurements in a subgroup. Adjusted Cox models were used to evaluate the associations of baseline and longitudinal changes in FM, LM, and WC over 1- and 4-year follow-up with risk of overall HF, HF with preserved ejection fraction (EF; EF ≥50%), HF with reduced EF (EF <50%), and MI. Results: Among 5103 participants, there were 257 incident HF events over 12.4 years of follow-up. Predicted and measured FM/LM were highly correlated ( R 2 =0.87–0.90; n=1369). FM and LM decreased over 4-year follow-up with greater declines in the intensive lifestyle intervention arm. In adjusted analysis, baseline body composition measures were not significantly associated with HF risk. Decline in FM and WC, but not LM, over 1 year were each significantly associated with lower risk of overall HF (adjusted hazard ratio per 10% decrease in FM, 0.80 [95% CI, 0.68–0.95]; adjusted hazard ratio per 10% decrease in WC, 0.77 [95% CI, 0.62–0.95]). Decline in FM was significantly associated with lower risk of both HF subtypes. In contrast, decline in WC was significantly associated with lower risk of HF with preserved EF but not HF with reduced EF. Similar patterns of association were observed for 4-year changes in body composition and HF risk. Longitudinal changes in body composition were not significantly associated with risk of MI. Conclusions: In adults with type 2 diabetes, a lifestyle intervention is associated with significant loss of FM and LM. Declines in FM and WC, but not LM, were each significantly associated with lower risk of HF but not MI. Furthermore, decline in WC was significantly associated with lower risk of HF with preserved EF but not HF with reduced EF. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT00017953.
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Decline in body fat mass was significantly associated with a lower risk of HFrEF and HFpEF, while decline in waist circumference was only significantly associated with a lower risk of HFpEF.
“The decline in body fat mass was significantly associated with a lower risk of HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF), while a decline in waist circumference was only significantly associated with a lower risk of HFpEF.59”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [59]
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- Authors
- Patel, K. V., Bahnson, J. L., Gaussoin, S. A., Johnson, K. C., Pi-Sunyer, X., White, U., Olson, K. L., Bertoni, A. G., Kitzman, D. W., Berry, J. D., Pandey, A., & On behalf of the Look AHEAD Research Group
- Affiliations
- Houston Methodist (US)
- Wake Forest University Health Sciences (US)
- University of Tennessee Health Science Center (US)
- Columbia University Irving Medical Center (US)
- Pennington Biomedical Research Center (US)
- Brown University (US)
- The University of Texas Southwestern Medical Center (US)
- ORCID
- Venue
- Circulation
- Published
- 2020-12-22
- Volume
- 142
- Issue
- 25
- Pages
- 2420-2430
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- PMC
- PMC8366747
- OpenAlex
- W3103720496
- Cited by
- 69
- References
- 38
- Citations by year
- 2026: 7 · 2025: 11 · 2024: 13 · 2023: 17 · 2022: 12 · 2021: 9
- FWCI
- 7.17
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Civil War Book Review (submittedVersion)
- Funders
- National Institutes of Health (5p30dk046204-15)
- National Institute on Aging (R01AG018915, R01AG045551, R03AG067960)
- National Heart, Lung, and Blood Institute (T32HL125247)
- National Institute of General Medical Sciences (U54GM104940)
- National Institute of Diabetes and Digestive and Kidney Diseases (U01DK057149, U01DK057151, U01DK057135, U01DK057131, U01DK056990, U01DK057136, U01DK057178, K23DK124578, U01DK057182, U01DK057078, U01DK057154, U01DK057008, U01DK057171, U01DK057002, U01DK057219, U01DK056992, U01DK057177, P30DK048520, P30DK072476, P30-DK046204)
- National Center for Research Resources (M01RR002719, M01RR000056, UL1RR025758, M01RR000051, M01RR001066, M01RR001346, UL1RR024153)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Keywords
- type 2 diabetes, heart failure, myocardial infarction, body composition, fat mass, lean body mass, waist circumference, weight loss, lifestyle intervention, Look AHEAD trial, preserved ejection fraction, reduced ejection fraction, atherosclerotic cardiovascular disease, dual-energy X-ray absorptiometry, cardiovascular risk factors, intensive lifestyle intervention
- MeSH terms
- Healthy Lifestyle, Heart Disease Risk Factors, Aged, Body Composition, Diabetes Mellitus, Type 2, Female, Heart Failure, Humans, Male, Middle Aged, Myocardial Infarction, Prognosis, Stroke Volume, Time Factors, Weight Loss, Exercise, Incidence, Ventricular Function, Left, Risk Assessment, Risk Reduction Behavior, Adiposity, Waist Circumference, Protective Factors
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