Improved fibrinolysis by intense lifestyle intervention. A randomized trial in subjects with impaired glucose tolerance


Lindahl B, Nilsson TK, Jansson J-H, Asplund K, Hallmans G (Departments of Nutritional Research, Clinical Chemistry and Medicine, Umea University, Sweden).

Improved fibrinolysis by in-tense lifestyle intervention. A randomized trial insubjects with impaired glucose tolerance. J. Intern Med 1999:246: 105-112.

Objective: To assess the effects of lifestyle intervention on cardiovascular risk factors in general and especially on fibrinolysis.

Design: Randomized clinical study.

Subjects: A total of 186 subjects with impairedglucose tolerance and obesity. Interventions. The intervention programme included a low-fat, high-fibre diet and regular physical exercise. Half of the participants (n= 93) took part in a one month learning and training session using different behavioural modification techniques and conducted in a full-board wellness centre (intense intervention group). The other half (n= 93) was randomized a one-hour counselling session with aspecially trained nurse (usual care group). Follow-up was carried out after 12 months.

Main outcome measures: Body weight, oxygenconsumption, plasminogen activator inhibitor type 1 (PAI-1) activity, tissue plasminogen activator(tPA) antigen, fibrinogen and fasting plasma insulinmeasured at the start of the programme and at follow-up after 1 year.

Results: The intense intervention group had a mean weight decline by 1 year of 5.4 kg compared to 0.5 kg in the usual care group. Oxygen consumption in the intense group increased 10% vs. a 1% decline in the usual care group. In the intense group, PAI-1 activity decreased 31% (-10.1 U mL-1), which was significantly more than in the usual care group (12%;-3.0 U mL-1). The corresponding reductions in tPA antigen were 14% (-1.65 µg L-1) and 6% (-0.69 µg L-1).

Conclusions: The present randomized study shows that an intense lifestyle programme has sustained beneficial effects on fibrinolysis.

Keywords: fibrinolysis, insulin resistance, nonphar-macologic, intervention, plasminogen activator in-hibitor.

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