Adherence
Intensive lifestyle intervention for weight loss in type 2 diabetes does not significantly reduce the primary composite cardiovascular endpoint (death from CV causes, nonfatal MI, nonfatal stroke, or hospitalization for angina) compared to diabetes support and education.
For people with type 2 diabetes, intensive lifestyle changes (diet and exercise) aiming for modest weight loss (7%) and activity (175 mins/week) did not statistically reduce the combined risk of heart attack, stroke, or CV death compared to standard support. However, achieving larger weight loss (10%+) and improved fitness was associated with reduced risk of CV death and major cardiac events. Continue lifestyle efforts for overall health and specific risk reduction, even if the broad 'heart attack prevention' claim is statistically unproven in this specific trial design.
Look AHEAD... was stopped on September 14, 2012, on the basis of a futility analysis of its composite primary end point (death from cardiovascular causes, nonfatal myocardial infarction [MI], nonfatal stroke, or hospitalization for angina)... Its results have been widely interpreted as evidence that weight loss with lifestyle intervention does not confer CVD benefits in patients with diabetes mellitus.
Why this rating
Large sample size (n=5145), long duration (median 9.6 years), but stopped for futility and had a high-intensity control arm.
Source
Looking Back at Look AHEAD Through the Lens of Recent Diabetes Outcome Trials
L. Maria Belalcazar et al. · Circulation · 2017
DOI 10.1161/circulationaha.116.024627
More from this paper
- In patients with type 2 diabetes, achieving >=10% weight loss in the first year of lifestyle intervention is associated with a significantly reduced risk of the primary composite cardiovascular outcome and cardiovascular death/MI/stroke.Moderate
- Intensive lifestyle intervention reduces total mortality and cardiovascular mortality in type 2 diabetes patients, with hazard ratios similar to those seen with SGLT2 inhibitors and GLP-1 agonists, although these reductions did not reach statistical significance in the Look AHEAD trial.Moderate
Related findings · Adherence
- Regular physical activity (at least 150 minutes/week of moderate-intensity) reduces all-cause and cardiovascular mortality by 20-30% and lowers the risk of type 2 diabetes by 25-35%.Strong
- Increasing physical activity from a sedentary lifestyle to an active one in middle adulthood significantly reduces the risk of coronary events compared to remaining sedentary.Strong
- Resistance exercise is the only intervention capable of consistently restoring muscle function and strength in sarcopenia, partially overcoming age-related anabolic resistance.Strong
This is one finding among thousands. Every one is graded and traced to its source, so you can see what the evidence actually supports. Browse the research →