The obesity paradox, cardiorespiratory fitness, and coronary heart disease

McAuley, Paul A., Artero, Enrique G., Sui, Xuemei, Lee, Duck-chul, Church, Timothy S., Lavie, Carl J., Myers, Jonathan N., Espana-Romero, Vanesa and Blair, Steven N. (2012) The obesity paradox, cardiorespiratory fitness, and coronary heart disease. Mayo Clinic Proceedings, 87 5: 443-451. doi:10.1016/j.mayocp.2012.01.013

Author McAuley, Paul A.
Artero, Enrique G.
Sui, Xuemei
Lee, Duck-chul
Church, Timothy S.
Lavie, Carl J.
Myers, Jonathan N.
Espana-Romero, Vanesa
Blair, Steven N.
Title The obesity paradox, cardiorespiratory fitness, and coronary heart disease
Journal name Mayo Clinic Proceedings   Check publisher's open access policy
ISSN 0025-6196
Publication date 2012-05-01
Sub-type Article (original research)
DOI 10.1016/j.mayocp.2012.01.013
Volume 87
Issue 5
Start page 443
End page 451
Total pages 9
Place of publication New York, NY, United States
Publisher Elsevier
Language eng
Formatted 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.
Keyword Body-composition
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Available online: 11 April 2012.

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2013 Collection
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