Improved fibrinolysis by an intensive lifestyle intervention in subjects with impaired glucose tolerance. The Finnish Diabetes Prevention Study.
OBJECTIVE
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
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.
Hämäläinen
H
H
Research Department, Social Insurance Institution, Turku, Finland. Helena.Hamalainen@kela.fi
Rönnemaa
T
T
Virtanen
A
A
Lindström
J
J
Eriksson
J G
JG
Valle
T T
TT
Ilanne-Parikka
P
P
Keinänen-Kiukaanniemi
S
S
Rastas
M
M
Aunola
S
S
Uusitupa
M
M
Tuomilehto
J
J
D000328:Adult; D003920:Diabetes Mellitus / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control; D004032:Diet; D015444:Exercise; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D005342:Fibrinolysis; D005387:Finland; D005500:Follow-Up Studies; D018149:Glucose Intolerance / Q000378:metabolism*; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D015431:Weight Loss
D017395:Plasminogen Activator Inhibitor 1; C051321:SERPINE1 protein, human; D005340:Fibrinogen