Losing Weight-And Keeping It Off-Can Free Patients From Atrial Fibrillation

Maintaining weight loss has many health benefits, and a study presented yesterday at the 64^th Annual Meeting of the American College of Cardiology added another item to the list: obese patients with atrial fibrillation who shed pounds are far more likely to rid themselves of this heart ailment.

For obese patients, weight loss might require support, as it did in the LEGACY study, which stands for Long Term Effect of Goal Directed Weight Management on an Atrial Fibrillation Cohort. But if patients lost at least 10% of their body weight, they were 6 times more likely to achieve arrhythmia-free survival.

The study, led by Rajeev Pathak, MD, a cardiologist and fellow in electrophysiology from the University of Adelaide, Australia, said LEGACY was the first to outline the benefits of sustained weight loss, the effects of the amount of weight lost, and the impact of changes in weight over time among patients who suffered from atrial fibrillation (AF), a condition that causes shortness of breath, weakness and can indicate stroke risk. Treatment typically includes anticoagulants, which can present their own risks in some patients.

“We found that sustained weight loss is achievable in obese patients and that it can significantly reduce the burden of atrial fibrillation,” Pathak said. Previous studies, he said, had examined only the short-term effects of weight loss on AF.

Researchers enrolled 355 participants in a weight loss clinic that provided support through 3 in-person visits a month, nutrition guidance, exercise, counseling, and a physical activity diary. All participants were obese (with a BMI of at least 27 kg/m²) and had AF at the start of the study, and all agreed to participate, a point that Pathak noted does bring some limitations to the results. Subjects with permanent AF, previous AF ablation, and severe medical illnesses were excluded.

Each year for 4 years, participants reported for a health exam and an assessment of their AF symptoms, based on their own reports and 7 days’ worth of readings from a Holter monitor. Patients also underwent an echocardiogram and sonogram of the measure heart health.

As subjects progressed, they were categorized based on the percentage of body weight lost. Symptom curves show that the AF burden decreased far more for those who lost the most weight, with both weight loss and weight fluctuation being independent predictors of outcomes. At the 4-year mark, 45% of patients who lost at least 10% of their weight, and 22% of those who lost 3-9% of the weight were free of AF symptoms—without the need for surgery or any medication. By contrast, only 13% of patients who lost less than 3% of their weight were symptom-free without such treatments.

Both sustained weight management and an absence of weight fluctuation were associated with a lack of AF symptoms. Those who lost and regained more than 5% of weight between annual visits were twice as likely to experience symptoms. Stable weight loss also helped patients achieve improved blood pressure, cholesterol and blood sugar levels.

The study was simultaneously published in the Journal of the American College of Cardiology.

Reference

Pathak R, et al. Long-term effect of goal directed weight management in an atrial fibrillation cohort: A long-term follow-up study (LEGACY Study). J Am Coll Cardiol 2015; DOI:101016/jacc.2015.03.002.