scholarly journals Association Between Change in Accelerometer-Measured and Self-Reported Physical Activity and Cardiovascular Disease in the Look AHEAD Trial

2022 ◽  
Author(s):  
John M. Jakicic ◽  
Robert I. Berkowitz ◽  
Paula Bolin ◽  
George A. Bray ◽  
Jeanne M. Clark ◽  
...  
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Proportional Hazards ◽  
Secondary Analysis ◽  
Cox Proportional Hazards ◽  
Self Report ◽  
Look Ahead ◽  
The Look

OBJECTIVE: To conduct <i>post-hoc</i> secondary analysis examining the association between change in physical activity (PA), measured with self-report and accelerometry, from baseline to 1 and 4 years and cardiovascular disease (CVD) outcomes in the Look AHEAD Trial. <p>RESEARCH DESIGN AND METHODS: Participants were adults with overweight/obesity and type 2 diabetes with PA data at baseline and year 1 or 4 (n = 1,978). Participants were randomized to diabetes support and education or intensive lifestyle intervention. Measures included accelerometry-measured moderate-to-vigorous PA (MVPA), self-reported PA, and composite (morbidity and mortality) CVD outcomes.</p> <p>RESULTS: In pooled analyses of all participants, using Cox proportional hazards models, each 100 MET-min/wk increase in accelerometry-measured MVPA from baseline to 4 years was associated with decreased risk of the subsequent primary composite outcome of CVD. Results were consistent for changes in total MVPA [HR=0.97 (95% CI: 0.95, 0.99)] and MVPA accumulated in <u>></u>10-minute bouts [HR=0.95 (95% CI: 0.91, 0.98)], with a similar pattern for secondary CVD outcomes. Change in accelerometry-measured MVPA at 1 year and self-reported change in PA at 1 and 4 years were not associated with CVD outcomes.</p> <p>CONCLUSIONS: Increased accelerometry-measured MVPA from baseline to year 4 is associated with decreased risk of CVD outcomes. This suggests the need for long-term engagement in MVPA to reduce the risk of CVD in adults with overweight/obesity and type 2 diabetes.</p>

scholarly journals Association Between Change in Accelerometer-Measured and Self-Reported Physical Activity and Cardiovascular Disease in the Look AHEAD Trial

2022 ◽  
Author(s):  
John M. Jakicic ◽  
Robert I. Berkowitz ◽  
Paula Bolin ◽  
George A. Bray ◽  
Jeanne M. Clark ◽  
...  
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Proportional Hazards ◽  
Secondary Analysis ◽  
Cox Proportional Hazards ◽  
Self Report ◽  
Look Ahead ◽  
The Look

OBJECTIVE: To conduct <i>post-hoc</i> secondary analysis examining the association between change in physical activity (PA), measured with self-report and accelerometry, from baseline to 1 and 4 years and cardiovascular disease (CVD) outcomes in the Look AHEAD Trial. <p>RESEARCH DESIGN AND METHODS: Participants were adults with overweight/obesity and type 2 diabetes with PA data at baseline and year 1 or 4 (n = 1,978). Participants were randomized to diabetes support and education or intensive lifestyle intervention. Measures included accelerometry-measured moderate-to-vigorous PA (MVPA), self-reported PA, and composite (morbidity and mortality) CVD outcomes.</p> <p>RESULTS: In pooled analyses of all participants, using Cox proportional hazards models, each 100 MET-min/wk increase in accelerometry-measured MVPA from baseline to 4 years was associated with decreased risk of the subsequent primary composite outcome of CVD. Results were consistent for changes in total MVPA [HR=0.97 (95% CI: 0.95, 0.99)] and MVPA accumulated in <u>></u>10-minute bouts [HR=0.95 (95% CI: 0.91, 0.98)], with a similar pattern for secondary CVD outcomes. Change in accelerometry-measured MVPA at 1 year and self-reported change in PA at 1 and 4 years were not associated with CVD outcomes.</p> <p>CONCLUSIONS: Increased accelerometry-measured MVPA from baseline to year 4 is associated with decreased risk of CVD outcomes. This suggests the need for long-term engagement in MVPA to reduce the risk of CVD in adults with overweight/obesity and type 2 diabetes.</p>

Abstract 018: Association of the Change in Physical Activity and Cardiovascular Disease Outcomes in the Look AHEAD Trial

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
John M Jakicic ◽  
Janet E Fulton ◽  
Wei Lang ◽  
Michael P Walkup
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Primary Outcome ◽  
Secondary Outcome ◽  
Look Ahead ◽  
The Look ◽  
Fatal Myocardial Infarction

Introduction: The Look AHEAD trial examined cardiovascular disease incidence in adults with type 2 diabetes randomly assigned to an intensive lifestyle intervention compared to those randomly assigned to diabetes support and education (control). In a substudy, physical activity was assessed using accelerometry, which provides an opportunity to examine whether the incidence of cardiovascular disease varied by the measured change in physical activity. Hypothesis: There is a beneficial association between the 1- and 4-year change in physical activity and the pre-specified primary and secondary outcomes in participants in the Look AHEAD trial. Methods: Adults (N=1,978; 59.1±6.8 kg; 102.8±19.0 kg) with type 2 diabetes at 8 study sites, who completed physical activity was assessment using accelerometry for 1 week at 0, 1, and 4 years. MET-minutes per week of moderate-to-vigorous physical activity (MVPA) performed in bouts of at least 10 minutes was identified from the accelerometry data. The 1- and 4-year change in MVPA was computed as the difference from baseline. The primary outcome was pre-defined as non-fatal myocardial infarction, stroke, hospitalized angina, and cardiovascular disease death. The first secondary outcome was pre-defined as non-fatal myocardial infarction, stroke, hospitalized angina, CABG/PTCA, hospitalized congestive heart failure, carotid endarterectomy, peripheral vascular disease, and total mortality. The relationships between 1- and 4-year change in physical activity and the primary and secondary outcomes were examined using Cox proportional hazards models with data collapses across the two treatment groups. Hazard ratios (HR) were adjusted for age, sex, history of cardiovascular disease, duration of diabetes, diabetes medication use, baseline weight, change in weight, and baseline physical activity. Results: MVPA [Median (25 th , 75 th percentile)] was 167.6 (0,545.5), 205.4 (0, 700.2), and 91.3 (0, 418.9) MET-minutes per week at 0, 1 and 4 years, respectively. Change in MVPA at 1-year was not significantly associated with the primary outcome [HR per 100 MET-minutes per week = 1.001 (95% CI: 0.985, 1.017)] or secondary outcome [HR per 100 MET-minutes per week = 0.989 (95% CI: 0.966, 1.013)] assessed across 8.8±2.4 years of follow-up. Change in MVPA at 4-years was significantly associated with a reduction in the primary [HR per 100 MET-minutes per week = 0.949 (95% CI: 0.912, 0.987)] and the secondary outcome [HR per 100 MET-minutes per week = 0.897 (95% CI: 0.843, 0.954)] assessed across 9.2±1.8 years of follow-up. Conclusions: Change in physical activity at 4-years is associated with a reduction in incidence of cardiovascular disease in adults with type 2 diabetes. These findings suggest improvements in physical activity may need to be sustained for a relatively long period (4 years) to elicit a beneficial effect on incidence of cardiovascular disease.

170-OR: Association of Timing of Physical Activity Bouts with Cardiorespiratory Fitness in Adults with Type 2 Diabetes in the Look AHEAD Study

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 170-OR
Author(s):  
JINGYI QIAN ◽  
MICHAEL P. WALKUP ◽  
SHYH-HUEI CHEN ◽  
PETER H. BRUBAKER ◽  
DALE BOND ◽  
...  
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Cardiorespiratory Fitness ◽  
Look Ahead ◽  
The Look

scholarly journals Cluster Analysis of Cardiovascular Phenotypes in Patients With Type 2 Diabetes and Established Atherosclerotic Cardiovascular Disease: A Potential Approach to Precision Medicine

2021 ◽  
Author(s):  
Abhinav Sharma ◽  
Yinggan Zheng ◽  
Justin A. Ezekowitz ◽  
Cynthia M. Westerhout ◽  
Jacob A. Udell ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Cluster Analysis ◽  
Proportional Hazards ◽  
Cardiovascular Death ◽  
Cox Proportional Hazards ◽  
Machine Learning Algorithms ◽  
Atherosclerotic Cardiovascular Disease ◽  
Asian Patients

<b>Objective:</b> Phenotypic heterogeneity among patients with type 2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular disease (ASCVD) is ill defined.<b> </b>We used cluster analysis machine learning algorithms to identify phenotypes among trial participants with T2DM and ASCVD. <p><b>Research Design and Methods:</b><i> </i>We used data from the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS) study (n=14,671), a cardiovascular outcome safety trial comparing sitagliptin with placebo in patients with T2DM and ASCVD (median follow-up 3.0 years). Cluster analysis using 40 baseline variables was conducted, with associations between clusters and the primary composite outcome (cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina) assessed by Cox proportional hazards models. We replicated the results using the Exenatide Study of Cardiovascular Event Lowering (EXSCEL) trial.</p> <p><b>Results:</b><i> </i>Four distinct phenotypes were identified: cluster I included Caucasian men with a high prevalence of coronary artery disease; cluster II included Asian patients with a low body mass index; cluster III included women with non-coronary ASCVD disease; and cluster IV included patients with heart failure and kidney dysfunction. The primary outcome occurred respectively in 11.6%, 8.6%, 10.3%, and 16.8% of patients in clusters I to IV. The crude difference in cardiovascular risk for the highest versus lowest risk cluster (cluster IV vs. II) was statistically significant (HR, 2.74; 95% CI, 2.29-3.29). Similar phenotypes and outcomes were identified in EXSCEL. </p> <p><b>Conclusions:</b><i> </i>In patients with T2DM and ASCVD, cluster analysis identified four clinically distinct groups. Further cardiovascular phenotyping is warranted to inform patient care and optimize clinical trial designs.</p>

scholarly journals Cluster Analysis of Cardiovascular Phenotypes in Patients With Type 2 Diabetes and Established Atherosclerotic Cardiovascular Disease: A Potential Approach to Precision Medicine

2021 ◽  
Author(s):  
Abhinav Sharma ◽  
Yinggan Zheng ◽  
Justin A. Ezekowitz ◽  
Cynthia M. Westerhout ◽  
Jacob A. Udell ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Cluster Analysis ◽  
Proportional Hazards ◽  
Cardiovascular Death ◽  
Cox Proportional Hazards ◽  
Machine Learning Algorithms ◽  
Atherosclerotic Cardiovascular Disease ◽  
Asian Patients

<b>Objective:</b> Phenotypic heterogeneity among patients with type 2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular disease (ASCVD) is ill defined.<b> </b>We used cluster analysis machine learning algorithms to identify phenotypes among trial participants with T2DM and ASCVD. <p><b>Research Design and Methods:</b><i> </i>We used data from the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS) study (n=14,671), a cardiovascular outcome safety trial comparing sitagliptin with placebo in patients with T2DM and ASCVD (median follow-up 3.0 years). Cluster analysis using 40 baseline variables was conducted, with associations between clusters and the primary composite outcome (cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina) assessed by Cox proportional hazards models. We replicated the results using the Exenatide Study of Cardiovascular Event Lowering (EXSCEL) trial.</p> <p><b>Results:</b><i> </i>Four distinct phenotypes were identified: cluster I included Caucasian men with a high prevalence of coronary artery disease; cluster II included Asian patients with a low body mass index; cluster III included women with non-coronary ASCVD disease; and cluster IV included patients with heart failure and kidney dysfunction. The primary outcome occurred respectively in 11.6%, 8.6%, 10.3%, and 16.8% of patients in clusters I to IV. The crude difference in cardiovascular risk for the highest versus lowest risk cluster (cluster IV vs. II) was statistically significant (HR, 2.74; 95% CI, 2.29-3.29). Similar phenotypes and outcomes were identified in EXSCEL. </p> <p><b>Conclusions:</b><i> </i>In patients with T2DM and ASCVD, cluster analysis identified four clinically distinct groups. Further cardiovascular phenotyping is warranted to inform patient care and optimize clinical trial designs.</p>

Abstract MP35: Discordant Visceral and Liver Fat Phenotypes are Differentially Associated With Incident Cardiovascular Disease and Type 2 Diabetes

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Sanaa Tejani
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Health Outcomes ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Liver Fat ◽  
Cardiometabolic Health ◽  
Study Cohort ◽  
Incident Cardiovascular Disease

Background: Visceral adipose tissue (VAT) and ectopic liver fat (ELF) are linked with cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) but little is known about their joint associations when they are discordant in an individual. Objective and Hypothesis: This study aims to evaluate cardiometabolic health outcomes associated with discordant VAT-ELF phenotypes in a multi-ethnic, population-based cohort of adults. We hypothesized that high VAT-low ELF, but not low VAT-high ELF, would be associated with incident cardiovascular disease, but both would be associated with incident T2DM. Methods: Participants of the Dallas Heart Study with no history of CVD or T2DM had assessments of VAT and ELF by MRI and MRS, respectively, between 2000 and 2002 and were followed for a median (IQR) of 12.0 (11.5-12.7) years for the incidence of CVD or T2DM. Associations between VAT-ELF phenotypes (high/low based on sex- and race-specific median values) and outcomes were evaluated using multivariable adjusted Cox proportional hazards and logistic regression models, as appropriate. Results: The study cohort included 1731 participants (mean age 43, 54% female, 44% black, 18% Hispanic, 41% obese). 128 (7.4%) participants had incident CVD and 95 (5.5%) had incident T2DM during follow-up. In unadjusted models, those with high VAT-low ELF had the highest hazard for CVD ( Table ), but associations were attenuated after multivariable adjustment. In both unadjusted and adjusted models, high VAT and/or high ELF phenotypes were associated with T2DM, with the high VAT-high ELF phenotype demonstrating the highest odds for T2DM ( Table ). Conclusions: In conclusion, we found that the heterogeneous manifestations of abdominal obesity impact cardiometabolic health outcomes. Elevated liver fat in the presence of low or normal VAT is associated with incident T2DM but not CVD.

Physical Activity Reduces Type 2 Diabetes Risk in Aging Independent of Body Weight Change

2004 ◽  
Vol 1 (1) ◽  
pp. 19-28 ◽  
Author(s):  
James Dziura ◽  
Stanislav V. Kasl ◽  
Loretta Di Pietro
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Body Weight ◽  
Older People ◽  
Proportional Hazards ◽  
Statistical Significance ◽  
Protective Role ◽  
Cox Proportional Hazards ◽  
Diabetes Risk

Background:It is not clear whether physical activity can exert a protective role on diabetes risk in older people that is independent of the changes in body weight that occur with both aging and disuse. The purpose of this analysis was to determine the relation between current physical activity, 3-year change in body weight, and the subsequent risk of type 2 diabetes in an older cohort.Methods:We studied prospectively 2,135 older (≥65 years) persons living in New Haven, CT, between 1982 and 1994. Physical activity was self-reported in 1982 and again in 1985; body weight and diabetes were self-reported annually over 12 years. Data were analyzed using multivariable Cox Proportional Hazards modeling with adjustments for age, sex, race, education, body mass index (BMI), smoking, chronic conditions, physical function, and alcohol intake.Results:Although an inverse graded relation was observed between level of activity and rate of diabetes, this dose–response relation did not reach statistical significance. However, older people who reported at least some activity at baseline experienced a significantly lower rate of diabetes between 1983 and 1994 compared to those reporting no activity (RR = 0.55; 95%CI = 0.35, 0.87). When 3-year changes in physical activity and body weight between 1982 and 1985 were added to the model, the relation between physical activity and reduced diabetes risk was unchanged (RR = 0.49; 95%CI = 0.24, 0.99).Conclusions:Even in advanced age, physical activity exerts an important and independent role in the prevention of type 2 diabetes. Continued physician counseling on the health effects of physical activity and referrals to community-based exercise programs should be encouraged among older people.

Sign in / Sign up

Export Citation Format

Share Document