The Obesity Paradox, Cardiorespiratory Fitness, and Coronary Heart Disease

• Published in: Mayo Clinic proceedings Vol. 87; no. 5; pp. 443 - 451
• Main Authors: McAuley, Paul A., PhD, Artero, Enrique G., PhD, Sui, Xuemei, MD, Lee, Duck-chul, PhD, Church, Timothy S., MD, MPH, PhD, Lavie, Carl J., MD, Myers, Jonathan N., PhD, España-Romero, Vanesa, PhD, Blair, Steven N., PED
• Format: Journal Article
• Language: English
• Published: Rochester, MN Elsevier Inc 01.05.2012; Mayo Foundation; Elsevier, Inc; Elsevier Limited
• Subjects: Adiposity; Aged; Biological and medical sciences; Body Composition; Body Mass Index; Body Weight; Cardiology. Vascular system; Cardiovascular diseases; Cardiovascular Physiological Phenomena; Cause of Death; Comorbidity; Complications and side effects; Confidence Intervals; Coronary Disease - epidemiology; Coronary Disease - physiopathology; Coronary heart disease; Exercise; Follow-Up Studies; General aspects; Health Status; Heart; Humans; Internal Medicine; Longitudinal Studies; Male; Medical sciences; Metabolic diseases; Middle Aged; Mortality; Obesity; Obesity - epidemiology; Obesity - physiopathology; Odds Ratio; Original; Physical Fitness; Respiratory Physiological Phenomena; Risk Factors; United States; Waist-Hip Ratio; United States; cardiovascular disease; HTN; BF; waist circumference; body mass index; CI; DM; diabetes mellitus; HR; WC; CVD; cardiorespiratory fitness; CRF; ACLS; hazard ratio; Aerobics Center Longitudinal Study; coronary heart disease; confidence interval; hypertension; CHD; body fat; BMI; Medicine; Obesity; Nutrition disorder; Cardiovascular risk; Cardiovascular disease; Circulatory system; Respiratory system; Coronary heart disease; Nutritional status
• ISSN: 0025-6196; 1942-5546
• DOI: 10.1016/j.mayocp.2012.01.013

Abstract Objective To investigate associations of cardiorespiratory fitness (CRF) and different measures of adiposity with cardiovascular disease (CVD) and all-cause mortality in men with known or suspected coronary heart disease (CHD). Patients and Methods We analyzed data from 9563 men (mean age, 47.4 years) with documented or suspected CHD in the Aerobics Center Longitudinal Study (August 13, 1977, to December 30, 2002) using baseline body mass index (BMI) and CRF (quantified as the duration of a symptom-limited maximal treadmill exercise test). Waist circumference (WC) and percent body fat (BF) were measured using standard procedures. Results There were 733 deaths (348 of CVD) during a mean follow-up of 13.4 years. After adjustment for age, examination year, and multiple baseline risk factors, men with low fitness had a higher risk of all-cause mortality in the BMI categories of normal weight (hazard ratio [HR], 1.60; 95% confidence interval [CI], 1.24-2.05), obese class I (HR, 1.38; 95% CI, 1.04-1.82), and obese class II/III (HR, 2.43; 95% CI, 1.55-3.80) but not overweight (HR, 1.09; 95% CI, 0.88-1.36) compared with the normal-weight and high-fitness reference group. We observed a similar pattern for WC and percent BF tertiles and for CVD mortality. Among men with high fitness, there were no significant differences in CVD and all-cause mortality risk across BMI, WC, and percent BF categories. Conclusion In men with documented or suspected CHD, CRF greatly modifies the relation of adiposity to mortality. Using adiposity to assess mortality risk in patients with CHD may be misleading unless fitness is considered.