Abstract P101: Effect of an Intensive Lifestyle Intervention on Biomarkers of Atrial Fibrillation-Related Pathways Among Overweight Adults: The PREDIMED-PLUS Trial

Abstract

Background: Lifestyles influence atrial fibrillation (AF) risk. Blood biomarkers can characterize the atrial substrate that facilitates the development of AF. Therefore, determining the effect of lifestyle interventions on blood concentrations of biomarkers of AF-related pathways could help understand AF pathophysiology and contribute to AF prevention. Methods: The PREDIMED-PLUS study is a Spanish multicenter randomized trial in adults (55-75 years) with metabolic syndrome and body mass index between 27-40 kg/m 2 . Participants were randomized 1:1 to an intensive lifestyle intervention (ILI) program, emphasizing physical activity, weight loss, and adherence to the Mediterranean diet, or a control intervention. In a sub-sample, serum biomarkers including carboxy-terminal propeptide of procollagen type I (PICP), high-sensitivity troponin T (hsTnT), high-sensitivity C reactive protein (hsCRP), N-terminal propeptide of B-type natriuretic peptide (NT-proBNP), and 3-nitrotyrosine (3-NT) were measured at baseline and years 3 and 5 after randomization. Mixed models were used to evaluate the effect of ILI on changes in biomarkers through years 3 and 5. Follow-up time was modeled as a categorical and continuous variable. Results: Of 481 participants (65 mean age, 40% female, 49% assigned to ILI), 453 (94%) and 442 (92%) had available samples at years 3 and 5. After 5 years, mean changes in log-transformed biomarkers were -0.01 (PICP), 0.20 (hsTnT), -0.17 (hsCRP), 0.12 (3-NT), and 0.25 (NT-proBNP). Participants in the ILI group experienced greater decreases in hsCRP or smaller increases in 3-NT, NT-proBNP, and in hsTnT to a lesser extent, as compared to the control group (Table). The ILI did not affect PICP concentrations. Results were consistent when modeling follow-up time as a continuous variable. Conclusion: Over five years, an ILI favorably affected concentrations of hsCRP, 3-NT, and NT-proBNP, and of hs-TnT to a lesser degree, pointing to specific mechanisms in the pathways linking lifestyles and AF.

Effect of an intensive lifestyle intervention on the structural and functional substrate for atrial fibrillation in people with metabolic syndrome

“…In addition, the COVID-19 pandemic might have had an impact of the trial conduct, though no major effects have been observed in previous reports. 25 Our intervention has effect on some biomarkers that are also surrogates for AF, 26 but might have little influence in echo parameters should they be already altered before enrolment in the trial (e.g., long-standing obesity). 27 There were no significant differences in LA longitudinal strain and LA emptying fraction according to changes in each individual component of the intervention, which was consistent with the lack of treatment effect on the primary outcomes.…”

Atrial Fibrillation and Lifestyle Modification: Charting New Courses for Cardiovascular Health

“…These lifestyle choices play an integral role in the intricate web of AF pathogenesis, extending beyond genetic and electrophysiological factors [39]. There is increasing interest in understanding and measuring behavioral risk factors associated with AF, such as alcohol consumption, sedentariness, and smoking, in order to reduce stroke risk [40]. Studies have shown that lifestyle interventions, emphasizing physical activity, weight loss, and adherence to a Mediterranean diet, can have a favorable effect on blood concentrations of biomarkers related to AF pathways, such as high-sensitivity C reactive protein (hsCRP), 3-nitrotyrosine (3-NT), and N-terminal propeptide of B-type natriuretic peptide (NT-proBNP) [33].…”