obese patients in afib

Can weight loss help atrial fibrillation (Afib) ? Mandrola and Krumholtz say yes and support Abed et al.

lean food on plate  Can weight loss help atrial fibrillation (Afib) ?

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lean food on plate  Can weight loss help atrial fibrillation (Afib) ?

A fascinating study in JAMA was the center of a Commentary by Mandrola and Krumholtz January 22, 2015. The original study in the Journal of the American Medical Association (JAMA 2013;19:2050-60) was the Effect of weight reduction and cardiometabolic risk factor management on symptom burden and severity in patients with atrial fibrillation: a randomized clinical trial. This study asked if weight reduction and aggressive treatment of heart and metabolic risk (cardiometabolic) factors could lower the burden and severity of symptoms in atrial fibrillation. The answer is yes.

Losing weight and intensive risk factor management decreased in symptoms of atrial fibrillation AND burden of AFib as well as beneficial cardiac remodeling. The reviewers called the study disruptive in the sense that it changes the established thinking about atrial fibrillation treatment. Mandrola and Krumholtz point out that most AFib patients get care late in the disease and care is directed at preventing symptoms and controlling complications. They astutely note that existing strategies do not address root causes of atrial fibrillation-LIFESTYLE factors and the resultant structural changes in the heart.

I heartily concur with their conclusion that weight reduction and aggressive targeting of cardiometabolic risk factors should be a new standard of care in the treatment of patients with atrial fibrillation.  This again points to exercise as a medicine for the family and lowering of heart risk wherever possible! I’ll be mentioning this in my authors note for the 25th edition of The Essential Guide to Prescription Drugs. Perhaps building weight/overweight and risk into every physician and pharmacist office visit is a paradigm we can all live longer with!

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