Australian research shows for the first time that obese people who are suffering from atrial fibrillation can reduce or reverse the effects of the condition by losing weight. The researchers found that a 10% loss in weight along with management of associated risk factors, can reverse the progression of the disease. They studied 355 overweight or obese people who lost varying amounts of weight.
The research was led by the Centre for Heart Rhythm Disorders at the University of Adelaide and the South Australian Health and Medical Research Institute (SAHMRI). “This is the first time that evidence has been found that if people who are obese and are suffering from atrial fibrillation the disease can be alleviated by losing weight and treating lifestyle factors,” says lead author Dr Melissa Middeldorp, researcher from the University of Adelaide’s Centre for Heart Rhythm Disorders.
Atrial fibrillation (AF), Australia’s most common heart rhythm disorder, is a leading cause of stroke and can lead to heart failure. Millions of people around the world are diagnosed with this condition every year. Chest pain, a “racing” or unusual heart beat and shortness of breath are all symptoms of AF.
“AF is a progressive disease in which initial short, intermittent symptoms develop into more sustained forms of the condition. Obesity and lifestyle factors are associated with its progression,” says Middeldorp.
The number of overweight and obese adults has doubled over the past two decades, with Australia now being ranked as one of the fattest developed nations. “The study showed that if obese people lose more than 10% of their weight and subsequent management of other risks to their lifestyle, they can reverse the progression of the disease. People who lost weight experienced fewer symptoms, required less treatment and had better outcomes. Those who previously had sustained symptoms experienced only intermittent symptoms or indeed stopped experiencing AF entirely,” says Middeldorp.
“Progression of the disease is shown to have a direct link with the degree of weight loss. Without weight loss, there is a progression of AF to more persistent forms of AF.”
The Centre for Heart Rhythm Disorders is led by Professor Prash Sanders, world leader in atrial fibrillation research. “This study shows that weight-loss and treating lifestyle factors is an essential component for effectively managing AF, in many instances being an alternative to surgery or drug intervention. Melissa’s work has widespread implications for the management of this disease globally and is good news for people with the condition,” says Sanders.
“With record levels of obesity in Australia and in most high-income countries, this study gives hope that obese people can have a better quality of life as well as reducing their dependence on health-care services if they lose weight.”
Aims: Atrial fibrillation (AF) is a progressive disease. Obesity is associated with progression of AF. This study evaluates the impact of weight and risk factor management (RFM) on progression of the AF.
Methods and results: As described in the Long-Term Effect of Goal-Directed Weight Management in an Atrial Fibrillation Cohort: A Long-Term Follow-Up (LEGACY) Study, of 1415 consecutive AF patients, 825 had body mass index ≥ 27 kg/m2 and were offered weight and RFM. After exclusion, 355 were included for analysis. Weight loss was categorized as: Group 1 (<3%), Group 2 (3–9%), and Group 3 (≥10%). Change in AF type was determined by clinical review and 7-day Holter yearly. Atrial fibrillation type was categorized as per the Heart Rhythm Society consensus. There were no differences in baseline characteristic or follow-up duration between groups (P = NS). In Group 1, 41% progressed from paroxysmal to persistent and 26% from persistent to paroxysmal or no AF. In Group 2, 32% progressed from paroxysmal to persistent and 49% reversed from persistent to paroxysmal or no AF. In Group 3, 3% progressed to persistent and 88% reversed from persistent to paroxysmal or no AF (P < 0.001). Increased weight loss was significantly associated with greater AF freedom: 45 (39%) in Group 1, 69 (67%) in Group 2, and 116 (86%) in Group 3 (P ≤ 0.001).
Conclusion: Obesity is associated with progression of the AF disease. This study demonstrates the dynamic relationship between weight/risk factors and AF. Weight-loss management and RFM reverses the type and natural progression of AF.
Melissa E Middeldorp, Rajeev K Pathak, Megan Meredith, Abhinav B Mehta, Adrian D Elliott, Rajiv Mahajan, Darragh Twomey, Celine Gallagher, Jeroen M L Hendriks, Dominik Linz, R Doug McEvoy, Walter P Abhayaratna, Jonathan M Kalman, Dennis H Lau, Prashanthan Sanders