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Improvement of left ventricular function by lifestyle intervention in obesity: contributions of weight loss and reduced insulin resistance

Citation

Kosmala, W and O'Moore-Sullivan, T and Plaksej, R and Przewlocka-Kosmala, M and Marwick, TH, Improvement of left ventricular function by lifestyle intervention in obesity: contributions of weight loss and reduced insulin resistance, Diabetologia, 52, (11) pp. 2306-2316. ISSN 0012-186X (2009) [Refereed Article]

Copyright Statement

Copyright 2009 Springer

DOI: doi:10.1007/s00125-009-1507-4

Abstract

Aims/hypothesis Weight excess and insulin resistance mediate the link between obesity and left ventricular dysfunction. We investigated the effect and mechanisms of lifestyle modification on left ventricular function changes in obese patients.
Methods Reduction of body weight and insulin resistance was sought using a behavioural intervention programme including dietary restrictions and exercise training in 261 patients (age 4513 years) with BMI ≥30 kg/m2, no history of cardiac disease and a normal stress echocardiogram. Each patient underwent echocardiographic measurement of myocardial deformation and velocity at baseline and at 6 month follow-up.
Results Improvements in left ventricular systolic and diastolic function were demonstrated only in patients with significant reduction of weight and/or insulin resistance. Left ventricular improvement was less frequent in patients with diabetes than in those without (52% vs 82% for strain, 50% vs 81% for strain rate and 59% vs 80% for peak early diastolic myocardial velocity). The independent predictors of improved left ventricular systolic function (increase in strain) were: weight reduction (β=0.14, p<0.05), decrease in the HOMA insulin resistance index (β=0.20, p<0.005) and absence of diabetes (β=0.18, p<0.02). A decrease in HbA1c also predicted improvement of left ventricular diastolic function (β=0.26, p<0.001). There was a parallel increment in exercise capacity with intervention and increase in strain was independently correlated with increase in VO2 (β=0.13, p<0.04).
Conclusions/interpretation Effective lifestyle modifications in obese patients improve left ventricular systolic and diastolic function, but appear less effective with coexisting diabetes. The reversal of left ventricular function abnormalities is associated with reduction of both weight and insulin resistance, and is accompanied by an increase in cardiorespiratory fitness.

Item Details

Item Type:Refereed Article
Keywords:echocardiography, insulin resistance, lifestyle intervention, myocardial dysfunction, obesity
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Cardiology (incl. Cardiovascular Diseases)
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
Author:Marwick, TH (Professor Tom Marwick)
ID Code:90753
Year Published:2009
Web of Science® Times Cited:26
Deposited By:Menzies Institute for Medical Research
Deposited On:2014-04-23
Last Modified:2014-12-17
Downloads:0

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