Cardiorespiratory fitness and mortality in diabetic men with and without cardiovascular disease

McAuley, Paul; Myers, Jonathan; Emerson, Brian; Oliveira, Ricardo B.; Blue, Carolyn L.; Pittsley, Jesse; Froelicher, Victor

doi:10.1016/j.diabres.2009.05.012

Cited by 17 publications

(7 citation statements)

References 14 publications

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“…All subjects gave informed written consent for participation in the study and the institutional review boards at both sites approved the study. Additional information on study methods and subject characteristics of this cohort has been published elsewhere [7]. For this analysis, we excluded participants: (1) with missing data ( n = 175); (2) with BMI <18.5 kg/m 2 ( n = 51); (3) under 40 and over 65 years of age ( n = 2528); (4) with documented CVD (defined as history of myocardial infarction, CAD documented via angiogram, abnormal exercise testing via a graded exercise test, coronary angioplasty, coronary bypass surgery, chronic heart failure, stroke, and/or peripheral vascular disease) ( n = 2510); (5) with diabetes ( n = 321); (6) who ever smoked ( n = 1379).…”

Section: Methodsmentioning

confidence: 99%

The Obesity Paradox and Cardiorespiratory Fitness

et al. 2012

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Cardiorespiratory fitness as an explanation for the obesity paradox warrants further examination. We evaluated independent and joint associations of cardiorespiratory fitness and adiposity with all-cause mortality in 811 middle-aged (age, 53.3 ± 7.2 years) male never smokers without documented cardiopulmonary disease or diabetes from the Veterans Exercise Testing Study (VETS). Cardiorespiratory fitness was quantified in metabolic equivalents (METs) using final treadmill speed and grade achieved on a maximal exercise test. Subjects were grouped for analysis by METs: unfit (lowest third) and fit (upper two-thirds); and by body mass index (kg/m2): nonobese (18.5−29.9) and obese (≥30.0). Associations of baseline fitness and adiposity measures with all-cause mortality were determined by Cox proportional hazards analysis adjusted for age, ethnicity, hypertension, hypercholesterolemia, family history of coronary artery disease, and cardiovascular medication use. In multivariate analysis, mortality risk for obese/fit men did not differ significantly from the nonobese/fit reference group. However, compared to the reference group, nonobese and obese unfit men were 2.2 (P = 0.01) and 1.9 (P = 0.03) times more likely to die, respectively. Cardiorespiratory fitness altered the obesity paradox such that mortality risk was lower for both obese and nonobese men who were fit.

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Section: Methodsmentioning

confidence: 99%

The Obesity Paradox and Cardiorespiratory Fitness

et al. 2012

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“…8,[12][13][14][15][16][17][18][19][82][83][84] However, although the evidence that CRF is inversely associated with mortality is strong and convincing, it does not necessarily mean that CRF directly enhances CVD mortality risk prediction. For CRF to truly be a novel risk marker, it must improve risk prediction beyond traditional markers.…”

Section: Application Of Crf To Reclassification Of Cardiovascular Riskmentioning

confidence: 99%

Importance of Assessing Cardiorespiratory Fitness in Clinical Practice: A Case for Fitness as a Clinical Vital Sign: A Scientific Statement From the American Heart Association

Ross¹,

Blair²,

Arena³

et al. 2016

Circulation

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ABSTRACT:Mounting evidence has firmly established that low levels of cardiorespiratory fitness (CRF) are associated with a high risk of cardiovascular disease, all-cause mortality, and mortality rates attributable to various cancers. A growing body of epidemiological and clinical evidence demonstrates not only that CRF is a potentially stronger predictor of mortality than established risk factors such as smoking, hypertension, high cholesterol, and type 2 diabetes mellitus, but that the addition of CRF to traditional risk factors significantly improves the reclassification of risk for adverse outcomes. The purpose of this statement is to review current knowledge related to the association between CRF and health outcomes, increase awareness of the added value of CRF to improve risk prediction, and suggest future directions in research. Although the statement is not intended to be a comprehensive review, critical references that address important advances in the field are highlighted. The underlying premise of this statement is that the addition of CRF for risk classification presents health professionals with unique opportunities to improve patient management and to encourage lifestyle-based strategies designed to reduce cardiovascular risk. These opportunities must be realized to optimize the prevention and treatment of cardiovascular disease and hence meet the American Heart Association's 2020 goals.M ounting evidence over the past 3 decades has firmly established that low levels of cardiorespiratory fitness (CRF) are associated with a high risk of cardiovascular disease (CVD) and all-cause mortality, as well as mortality rates attributable to various cancers, especially of the breast and colon/digestive tract. [1][2][3][4] Importantly, improvements in CRF are associated with reduced mortality risk.5 Although CRF is now recognized as an important marker of cardiovascular health, it is currently the only major risk factor not routinely assessed in clinical practice.In 2013, the American Heart Association and the American College of Cardiology jointly released new guidelines for the prevention and treatment of coronary artery disease.6 Although CRF is the fourth-leading risk factor for CVD and has long been established as a significant prognostic marker, 7 it was excluded from the risk calculator. The authors of the guidelines noted that the evidence that CRF would enhance risk classification was inconclusive, and thus, the added contribution of CRF to determine CVD risk was uncertain. There is, however, a large body of epidemiological and clinical evidence demonstrating not only that CRF is a potentially stronger predictor of mortality than established risk factors such as smoking, hypertension, high cholesterol, and type 2 diabetes mellitus (T2DM), but that the addition of CRF to traditional risk factors significantly improves the reclassification of risk for adverse outcomes.

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“…48 McAuley et al, in the Veterans Exercise Testing study (n=7,775), observed that in men with T2DM (without baseline CVD) those with high CRF had 2.5-and 3.8-fold reductions in all-cause mortality risk compared to men in the moderate or low CRF categories, respectively, after multivariate adjustments. 49 Berry et al observed in men in the ACLS dataset (n=11,049) that low levels of CRF were associated with a higher lifetime risk of CV mortality to age 80 years, with markedly lower rates at 45 (high CRF: 3.4 vs. low CRF: 12.2%), 55 (high CRF: 4.9 vs. low CRF: 19.6%) and 65 (high CRF: 5.6 vs. low CRF: 12.2%) years old compared to those with low levels of CRF. 50 Especially notable in their findings, men with a high burden of traditional CV risk factors, but with a high level of CRF, had lifetime CV mortality rates that were similar to those with a low burden of traditional CVD risk factors.…”

Section: Crf and CV Riskmentioning

confidence: 99%