Veterans Affairs Medical Center, Department of Cardiology, Washington, DC, USA.
Department of Kinesiology and Health, Rutgers University, New Brunswick, NJ, USA.
Eur J Heart Fail. 2019 Apr;21(4):436-444. doi: 10.1002/ejhf.1433. Epub 2019 Feb 19.
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.
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/m ), overweight (25-29.9 kg/m ), and obese (≥ 30.0 kg/m ). 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.
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.
肥胖与心力衰竭（HF）风险增加相关。心肺适能（CRF）的改善可能会调节这种风险，因为 CRF 与有利的健康结果相关。因此，我们评估了体重指数（BMI）、CRF 和 HF 之间的相互作用。
在 20254 名美国男性退伍军人（平均年龄 58.0±11.3 岁）中评估了 CRF 和 BMI，他们在 1987 年至 2017 年间完成了最大运动量跑步机测试。所有患者在进行运动测试前均无缺血或 HF 的证据。他们根据达到的最大代谢当量（METs）的年龄分层四分位数进行分类：最差（4.5±1.3）、低（6.7±1.3）、中（8.1±1.1）和高（11.2±2.4）；并根据 BMI 分为正常体重（18.5-24.9kg/m2）、超重（25-29.9kg/m2）和肥胖（≥30.0kg/m2）。在中位随访 13.4 年期间，发生了 2979 例 HF 事件（10.8 例/1000 人年）。肥胖组的 HF 风险明显更高[风险比（HR）1.22，95%置信区间（CI）1.10-1.36；P<0.001]，但进一步调整 METs 后，这种差异不再显著。与最差的相比，在所有 BMI 类别中，随着 CRF 的增加，HF 风险逐渐降低。在正常体重、超重和肥胖类别中，高 FIT 个体的 HF 风险分别降低 63%（HR0.37，95%CI0.30-0.47；P<0.001）、66%（HR0.37，95%CI0.28-0.40；P<0.001）和 73%（HR0.27，95%CI0.22-0.34；P<0.001）。
无论 BMI 如何，CRF 的增加都与 HF 风险的降低呈正相关，这表明与肥胖相关的 HF 风险可能通过改善 CRF 来调节。
