Lose Weight and You May Reverse Your Heart Disease

Lose Weight and You May Reverse Your Heart Disease

By T. Jared Bunch, MD

Published Mar 17, 2015

For heart disease prevention in patients with atrial fibrillation, weight loss efforts count, but endurance wins.

A number of years ago I cared for a retired football player. He was a college star and a fringe player professionally. His once fit body had succumbed to the consequences of many jaw-dropping hits as he attempted to catch passes over the middle of the football field. Since retirement, his activity levels had plummeted, and he became overweight and developed heart disease. Some of this change was due to chronic pain. However, a lot of it was due to a transition in life that led to less activity and weight gain.

When we met, he had high blood pressure, prediabetes, and atrial fibrillation. We talked about his health conditions and weight gain. We discussed lifestyle changes and the need to start medications for his high blood pressure, atrial fibrillation, and high cholesterol.

After this long discussion he said, “I am committed. I want to do this without medications.”

I actually hear this a lot. We will all face health problems, many of which come because of our lifestyles and choices. With the realization that disease has developed, we often use this moment to become motivated for change. Unfortunately, for most of us, sustaining high levels of motivation can be challenging, and we often fall back into more comfortable lifestyle habits. I believe there is merit in the initial desire to change. I also know that endurance is essential for lifestyle changes to work.

Medications make up for such human tendencies in most people with disease. They work immediately when motivation is high and often have a sustained benefit even if motivation is lost.

Medications are valuable in disease management, but a lot of my patients, like this athlete, believe there is a better way.

The ‘Lifestyle Effect’ on Blood Pressure and Cholesterol

At the American College of Cardiology 64th Annual Scientific Sessions in SanDiego, one study presented on March 16th focused on the value of our initial motivation to change, as well the additive value of endurance. Two outstanding researchers, Rajeev Pathak, MBBS, and Prashanthan Sanders, MBBS, PhD, from the University of Adelaide in Australia led the study. These are physicians committed to the long-term care of atrial fibrillation patients. Atrial fibrillation is one of the most common heart rhythm disorders and can cause stroke, heart failure, poor quality of life, and even death. These physicians know that, in most people, atrial fibrillation can be prevented and perhaps in those patients in whom it has already developed, the disease can be reversed.

The Australian study involved 355 patients who had developed atrial fibrillation. Unlike most clinics in the United States, the one where these patients were treated also sent them to a lifestyle modification clinic. Drs. Pathak and Sanders examined the impact of early weight loss after lifestyle counseling in the clinic. Their findings are reason for great optimism in those who have atrial fibrillation, high blood pressure, diabetes, or any combination of these diseases.

Here is a summary of what they reported:

1.            Blood pressure improved as the amount of weight loss increased — from less than 3 percent, to 3 percent to 9 percent, and then over 10 percent.
2.           Those patients who had more than a 10 percent weight loss were able to reduce their need for blood pressure medications by 50 percent, on average, while maintaining normal blood pressure levels.
3.         High cholesterol also improved. In those who experienced a 3 percent to 9 percent weight loss, cholesterol decreased by 25 milligrams per deciliter (mg/dL), on average.
4.         For those who lost more than 10 percent of their weight, the average cholesterol decrease was even better, approximately 45 mg/dL. The cholesterol improvement was observed in the group with the greatest weight loss despite the fact that 50 percent of them stopped taking their cholesterol medications. This is drug-free control of cholesterol.
5.         The group with more than 10 percent weight loss also had less diabetes — from 30 percent having prediabetes or diabetes to only 4 percent with these diseases at the last follow-up visit.

How Did the Heart Respond?

Data on patients’ hearts showed that when lifestyle changes are made, heart disease could be reversed. The heart chamber that creates atrial fibrillation decreased in size to near normal levels. The wall thickness of the heart, which typically is felt to be permanent despite use of medications, decreased, making the heart more flexible and adaptive. As a consequence, the amount of atrial fibrillation decreased dramatically.

In the group with weight loss of more than 10 percent, the burden of atrial fibrillation fell by 50 percent. In all weight loss categories, atrial fibrillation levels decreased from 20 percent to 50 percent. These patients reported that they felt better and their quality of life improved.

Lifestyle change was not a miracle cure, as many people still experienced some atrial fibrillation. But the study highlights the value of personal choices and lifestyle changes in disease management. The study provides evidence that you can take control of your health.

The study authors provided two important additional insights:

•                First, those who had sustained weight loss or continued to lose weight did the best. This is not overly surprising, but it gives us incentive to keep up the fight.

•                Second, those who lost weight initially and then gained it back still did better than those who never lost weight. In fact, even if their weight continued to fluctuate, they were 20 percent less likely to experience atrial fibrillation. This finding teaches us that initial effort is important as well, even if we slip up and have trouble keeping away from old habits.

What Was the Key to Long-Term Weight Loss?

The authors give a lot of credit to the use of a lifestyle clinic. Patients had the opportunity to use a team of professionals to help them. This team also made them accountable for change. Those who refused to participate in the clinic and did it on their own were most likely to not lose weight. This tells me we need to surround ourselves with a good supportive team that will expect us to endure and help us when times are difficult. This team may come from family, friends, and, hopefully, as prevention emphasis spreads in the United States, lifestyle clinics.

Kevin Durant, professional basketball player with the Oklahoma City Thunder of the National Basketball Association, provided insight into his greatness when during his Most Valuable Player award acceptance speech he said, “I failed so many and got back up. I’ve been through the toughest times with my family, but I’m still standing.”

We are all going to struggle, at times, with consistently making healthy decisions. This new study teaches us that it is worth it. It also teaches us that it is important to get back up each time we fall, and try again.

Photo credit: Hamza Tarkkol/Getty Images

Posted in: Atrial Fibrillation