BACKGROUND Type 2 diabetes mellitus (T2DM) is associated with a higher risk for heart failure (HF). The impact of a lifestyle intervention and changes in cardiorespiratory fitness (CRF) and body mass index on risk for HF is not well established. METHODS Participants from the Look AHEAD trial (Action for Health in Diabetes) without prevalent HF were included. Time-to-event analyses were used to compare the risk of incident HF between the intensive lifestyle intervention and diabetes support and education groups. The associations of baseline measures of CRF estimated from a maximal treadmill test, body mass index, and longitudinal changes in these parameters with risk of HF were evaluated with multivariable adjusted Cox models. RESULTS Among the 5109 trial participants, there was no significant difference in the risk of incident HF (n=257) between the intensive lifestyle intervention and the diabetes support and education groups (hazard ratio, 0.96 [95% CI, 0.75-1.23]) over a median follow-up of 12.4 years. In the most adjusted Cox models, the risk of HF was 39% and 62% lower among moderate fit (tertile 2: hazard ratio, 0.61 [95% CI, 0.44-0.83]) and high fit (tertile 3: hazard ratio, 0.38 [95% CI, 0.24-0.59]) groups, respectively (referent group: low fit, tertile 1). Among HF subtypes, after adjustment for traditional cardiovascular risk factors and interval incidence of myocardial infarction, baseline CRF was not significantly associated with risk of incident HF with reduced ejection fraction. In contrast, the risk of incident HF with preserved ejection fraction was 40% lower in the moderate fit group and 77% lower in the high fit group. Baseline body mass index also was not associated with risk of incident HF, HF with preserved ejection fraction, or HF with reduced ejection fraction after adjustment for CRF and traditional cardiovascular risk factors. Among participants with repeat CRF assessments (n=3902), improvements in CRF and weight loss over a 4-year follow-up were significantly associated with lower risk of HF (hazard ratio per 10% increase in CRF, 0.90 [95% CI, 0.82-0.99]; per 10% decrease in body mass index, 0.80 [95% CI, 0.69-0.94]). CONCLUSIONS Among participants with type 2 diabetes mellitus in the Look AHEAD trial, the intensive lifestyle intervention did not appear to modify the risk of HF. Higher baseline CRF and sustained improvements in CRF and weight loss were associated with lower risk of HF. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00017953.

中文翻译：

---

强化生活方式干预、健身和体重指数与超重或肥胖 2 型糖尿病成人心力衰竭风险的关联：Look AHEAD 试验的分析。

背景 2 型糖尿病 (T2DM) 与较高的心力衰竭 (HF) 风险相关。生活方式干预以及心肺健康 (CRF) 和体重指数的变化对 HF 风险的影响尚未确定。方法 包括未患 HF 的 Look AHEAD 试验（糖尿病健康行动）的参与者。事件发生时间分析用于比较强化生活方式干预组与糖尿病支持和教育组之间发生 HF 的风险。用多变量调整的 Cox 模型评估了从最大跑步机测试、体重指数和这些参数的纵向变化与 HF 风险估计的 CRF 基线测量值的关联。结果 在 5109 名试验参与者中，强化生活方式干预组与糖尿病支持和教育组之间发生 HF 的风险 (n=257) 没有显着差异（风险比，0.96 [95% CI，0.75-1.23]） 12.4 岁。在调整最多的 Cox 模型中，中度拟合（三分位数 2：风险比，0.61 [95% CI，0.44-0.83]）和高度拟合（三分位数 3：风险比，0.38）的 HF 风险分别降低 39% 和 62% [95% CI, 0.24-0.59]) 组，分别（参照组：低拟合，三分位数 1）。在 HF 亚型中，在调整传统心血管危险因素和心肌梗死间隔发生率后，基线 CRF 与射血分数降低的 HF 事件风险无显着相关性。相比之下，射血分数保留的 HF 事件风险在适度适合组中降低 40%，在高适合组中降低 77%。在调整 CRF 和传统心血管危险因素后，基线体重指数也与发生 HF、射血分数保留的 HF 或射血分数降低的 HF 的风险无关。在重复 CRF 评估的参与者 (n=3902) 中，4 年随访期间 CRF 的改善和体重减轻与心衰风险降低显着相关（CRF 每增加 10% 的风险比为 0.90 [95% CI， 0.82-0.99]；体重指数每下降 10%，0.80 [95% CI，0.69-0.94]）。结论 在 Look AHEAD 试验中患有 2 型糖尿病的参与者中，强化生活方式干预似乎没有改变 HF 的风险。较高的基线 CRF 以及 CRF 和体重减轻的持续改善与较低的 HF 风险相关。注册：网址：https://www.clinicaltrials.gov；唯一标识符：NCT00017953。