Effect of an intensive lifestyle intervention on circulating biomarkers of atrial fibrillation-related pathways among adults with metabolic syndrome

Determining the effect of lifestyle interventions on blood concentrations of biomarkers of atrial fibrillation (AF)-related pathways could help understand AF pathophysiology and contribute to AF prevention. We studied 471 participants enrolled in the PREDIMED-Plus trial, a Spanish randomized trial in adults with metabolic syndrome. Eligible participants were randomized 1:1 to an intensive lifestyle intervention, emphasizing physical activity, weight loss, and adherence to an energy-reduced Mediterranean diet or to a control group. Serum biomarkers [carboxy-terminal propeptide of procollagen type I (PICP), high-sensitivity troponin T (hsTnT), high-sensitivity C reactive protein (hsCRP), 3-nitrotyrosine (3-NT), and N-terminal propeptide of B-type natriuretic peptide (NT-proBNP)] were measured at baseline, 3 and 5 years after randomization. Mixed models were used to evaluate the effect of intervention on changes in biomarkers through year 5. Mediation analysis was performed to examine the proportion mediated by each component of the intervention. Compared to the control group, participants in the intervention group experienced greater decreases in hsCRP (-16%, 95% confidence interval (CI) - 28%, -1%) or smaller increases in 3-NT (-15%, 95% CI -25%, -4%) and NT-proBNP (-13%, 95% CI - 25%, 0%). The intervention had minimal impact on hsTnT (-3%, 95% CI -8%, 2%) or PICP concentrations (-0%, 95% CI -9%, 9%). The effect of the intervention on hsCRP was primarily mediated by weight loss (73% and 66% at years 3 and 5). In conclusion, a dietary and lifestyle intervention for weight-loss favorably affected concentrations of hsCRP, 3-NT, and NT-proBNP, pointing to specific mechanisms in pathways linking lifestyles and AF. Condensed abstractIn this study, we assessed the impact of an intensive lifestyle intervention on blood biomarkers related to atrial fibrillation (AF) pathways in 471 participants from the PREDIMED-Plus trial. The intervention focused on physical activity, weight loss, and an energy-reduced Mediterranean diet. Over five years, the intervention group showed greater decreases in high-sensitivity C reactive protein and smaller increases in 3-nitrotyrosine and N-terminal propeptide of B-type natriuretic peptide. Weight loss primarily mediated the effect of the intervention on high-sensitivity C reactive protein. These findings suggest that dietary and lifestyle changes may influence biomarkers involved in AF pathophysiology. Key pointsRandomized clinical trial, lifestyle, biomarker, atrial fibrillation