Comparing Body Weight vs Fat Mass Changes on Reducing Heart Failure Risk in Diabetics

Ambarish Pandey, MD

New research from a team at the UT Southwestern Medical Center suggests that not all weight loss is equal for patients with type 2 diabetes looking to reduce their risk of cardiovascular disease.

AN analysis of data from the Look AHEAD Trial, results indicate reductions in fat mass (FM), lean mass (LM), and waist circumference (WC) can all have varying effects on mitigating risk for heart failure and myocardial infarction in diabetic patients.

“We have long counseled patients to lower their body-mass index into the ‘healthy’ range. But that doesn’t tell us whether a patient has lost ‘fat mass’ or ‘lean mass,’ or where the weight came off,” said lead investigator Ambarish Pandey, MD, assistant professor of internal medicine at UTSW, in a statement. “We didn’t know how each of these factors might affect patients’ risk of heart disease.”

With a multitude of studies detailing links between intentional weight loss and reductions in risk for cardiovascular disease and major adverse cardiovascular events, investigators sought to further explore specific effects of changes in weight, body composition, and waist circumference. Using the Look AHEAD Trial, investigators identified a cohort of 5103 patients, including 257 that went on to develop heart failure during the 12.4-year follow-up period.

For the purpose of analysis, investigators predicated FM and LM using validated equations and compared with dual-energy x-ray absorptiometry measurements in a subgroup. Adjusted Cox models were used to evaluate associations of baseline and longitudinal changes in FM, LM, and WC among the study population over 1- and 4-year follow-up with risk of overall heart failure, heart failure with preserved ejection fraction (HFpEF), heart failure with reduced ejection fraction (HFrEF), and myocardial infarction.

In initial analyses, investigators found FM and LM were highly correlated (R2=.87-.90; n=1369). Both FM and LM decreased over the 4-year follow-up period, with greater decreases noted among those in the intensive lifestyle interventions arm.

In adjusted analysis, investigators found baseline body composition measures were not significantly associated with heart failure risk. Additionally, declines in FM and WC, but not LM, over 1-year were both associated with a significantly lower risk of overall heart failure. Investigators noted declines in FM were significantly associated with lower risk in both HFpEF and HFrEF.

Results indicated declines in WC were significantly associated with a lower risk of HFpEF but not HFrEF. Investigators pointed out similar patterns of association were observed when assessing 4-year changes in body composition and risk of heart failure. Results also indicated longitudinal changes in body composition were not significantly associated with risk of myocardial infarction.

“Our study suggests that simply losing weight is not enough,” Pandey added. “We may need to prioritize fat loss to truly reduce the risk of heart failure.”

This study, “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,” was published in Circulation.