Improved fibrinolysis by an intensive lifestyle intervention in subjects with impaired glucose tolerance. The Finnish Diabetes Prevention Study

Abstract

Aims/hypothesis: The aim of this study was to investigate the effects of lifestyle intervention on the levels of plasminogen activator inhibitor (PAI-1) and fibrinogen in subjects participating in the Finnish Diabetes Prevention Study (DPS). Methods: In five DPS centres, 321 subjects with impaired glucose tolerance (intervention group, n= 163; control group, n=158) had their PAI-1 and fibrinogen levels measured at baseline and at the 1-year follow-up. Additional 3-year follow-up assessments were carried out in a sample of 97 subjects in one of the DPS centres (Turku). The intervention programme included an intensive lifestyle intervention aiming at weight reduction, healthy diet and increased physical activity. Results: During the first intervention year, PAI-1 decreased by 31% in the intervention group but showed no change in the control group (p<0.0001). In the Turku subgroup, the decrease in PAI-1 persisted throughout the 3-year follow-up. Changes in PAI-1 were associated with the number of lifestyle changes made during the first year (p=0.008). Weight reduction was the most important factor explaining the decrease in PAI-1. Changes in fibrinogen levels did not differ between the groups. Conclusions/interpretation: In addition to the previously reported reduction in the risk of type 2 diabetes in DPS participants with impaired glucose tolerance, the intensive dietary and exercise intervention had beneficial long-term effects on fibrinolysis as indicated by the reduced levels of PAI-1. These results suggest that elevated PAI-1 levels in obese subjects with impaired glucose tolerance are mostly reversible by lifestyle changes, especially those geared to weight reduction.

The effect of increased dietary fruit and vegetable consumption on endothelial activation, inflammation and oxidative stress in hypertensive volunteers

“…Similar results have been reported for a 5 week soy-diet intervention in renal transplant patients [30]. While trials designed to produce weight loss describe associated reductions in plasma PAI-1 concentrations [31,32], more specific dietary interventions (for example, with fatty acids or Mediterranean diet) have generally failed to alter either fibrinolytic parameters or circulating vWF levels [33,34]. When 112 volunteers at increased cardiovascular risk were randomised to a low-fat or Mediterranean diet for 3 months, significantly reduced concentrations of plasma sICAM-1 and sVCAM-1 were observed in the latter group [35].…”

Non-pharmacological interventions to reduce the risk of diabetes in people with impaired glucose regulation: a systematic review and economic evaluation.

“…[205][206][207][208][209][210][211][212][213][214][215][216][217][218][219] Description and quality of trial This RCT of 523 participants with IGT in Finland compared intensive lifestyle intervention with a control group. Participants were recruited by screening high-risk individuals (e.g.…”

“…A reduction in fibrinolytic activity is thought to increase CVD. Hamalainen et al (2005) 206 reported that in five centres improvement in fibrinolytic activity was seen by 1 year [31% reduction in plasminogen activator inhibitor-1 (PAI-1)]. 206 In one centre (Turku) it was measured again at 3 years and was shown to persist.…”

Fat and Fatty Acid Intake and Metabolic Effects in the Human Body

“…There is probable evidence that the increase in FVIIa is greater following meals rich in MUFA (oleic acid) than for some sources of SFA [Sanders et al, 2000[Sanders et al, , 2006bTholstrup et al, 2003;Sanders and Berry, 2005;Berry et al, 2007a, b]. There is insufficient evidence to demonstrate chronic effects of different types of fatty acids on fibrinogen or fibrinolytic activity [Miller, 2005;Sanders et al, 2006b], but fibrinolytic activity improves with intensive lifestyle intervention (weight reduction and increased physical activity) [Hamalainen et al, 2005].…”