Cardiorespiratory fitness, body mass index and heart failure incidence

Abstract

Aims Obesity is associated with increased risk of heart failure (HF). This risk may be modulated by improved cardiorespiratory fitness (CRF) as CRF is associated with favourable health outcomes. Thus, we assessed the interaction between body mass index (BMI), CRF and HF. Methods and results Cardiorespiratory fitness and BMI were assessed in 20 254 US male veterans (mean age 58.0 ± 11.3 years), who completed a maximal exercise treadmill test between 1987 and 2017. All had no evidence of ischaemia or HF prior to the exercise test. They were classified based on age‐stratified quartiles of peak metabolic equivalents (METs) achieved as: least‐fit (4.5 ± 1.3), low‐fit (6.7 ± 1.3), moderate‐fit (8.1 ± 1.1), and high‐fit (11.2 ± 2.4); and according to BMI as normal weight (18.5–24.9 kg/m2), overweight (25–29.9 kg/m2), and obese (≥ 30.0 kg/m2). During a median follow‐up of 13.4 years, there were 2979 HF events (10.8 events/1000 person‐years). HF risk was significantly higher in the obese category [hazard ratio (HR) 1.22, 95% confidence interval (CI) 1.10–1.36; P < 0.001], but was no longer significant after further adjustment for METs. When compared to the least‐fit, HF risk declined progressively with increased CRF within all BMI categories. The risk was 63% (HR 0.37, 95% CI 0.30–0.47; P < 0.001), 66% (HR 0.37, 95% CI 0.28–0.40; P < 0.001), and 73% (HR 0.27, 95% CI 0.22–0.34; P < 0.001) lower for high‐fit individuals within normal weight, overweight and obese categories, respectively. Conclusions Increased CRF was associated with progressively lower HF risk regardless of BMI, suggesting that the elevated HF risk associated with obesity may be modulated by improved CRF.

Heart failure risk reduction: is fit and overweight or obese better than unfit and normal weight?

“…The current findings of Kokkinos et al . are very relevant and welcome, as they have several clinical implications for HF prevention.…”

“…There is little knowledge on the association and interaction between CRF, BMI, and incident HF. In this context, Kokkinos et al . have conducted an elegant and clinically valuable study that aimed to assess the interactive effect of CRF and BMI on the incidence of HF in US male veterans.…”

“…The strengths of this study include the large sample with adequate numbers of normal weight, overweight, and obese participants; the comprehensive panel of blood‐based markers, co‐morbidities, and lifestyle characteristics, which enabled adequate adjustment for potential confounders; and thorough statistical methods, which included interaction, dose–response and several sensitivity analyses . The limitations comprised (i) the use of an observational design, which is characterized by residual confounding, regression dilution and does not establish causality as acknowledged by the authors; (ii) findings being limited to men and therefore not generalizable to women; (iii) lack of data on PA patterns during follow‐up, which could have influenced CRF; (iv) absence of data on HF subtypes; and (v) CRF was not assessed using respiratory gas analysis [directly measured oxygen uptake (VO 2 )], which is a more objective and quantitative assessment of this measure.…”

Quality of Life and Physical Performance in Patients with Obesity: A Network Analysis

“…Obesity is a condition characterized by an excessive accumulation of fat in adipose tissue; it is linked to an increased risk of chronic diseases, disability, and mortality [1], and is also often associated with poor physical fitness levels, e.g., muscle strength [2], and cardiorespiratory fitness [3]. Moreover, both obesity and physical performance are associated with quality of life.…”

Fitness Equals Longer Life Expectancy Regardless of Adiposity Levels

“…10 Several reports have also observed that the association of obesity with adverse outcomes is reduced when factored for CRF levels. 11 These observations suggest that the association between obesity and increased CVD risk may reflect low CRF and that adverse consequences of obesity on CVD may be offset by improved levels of CRF. 12 Despite the minefield of evidence on the relationships among physical fitness, obesity, and adverse health outcomes, this interplay is still not well understood and is still debated.…”