Research Division, The Cooper Institute, Dallas, Texas.
Department of Medicine, Stanford University, Palo Alto, California.
J Womens Health (Larchmt). 2020 Mar;29(3):319-326. doi: 10.1089/jwh.2019.7793. Epub 2019 Sep 18.
Associations among cardiorespiratory fitness (CRF), different adiposity exposures, and cardiovascular disease (CVD) mortality in women are not well defined. A total of 19,838 women completed a baseline examination between 1971 and 2013. Measures included body mass index (BMI), waist circumference (WC), waist-to-height (W:HT) ratio, skinfold-derived percent body fat (% Fat), and CRF estimated from a maximal treadmill test. CRF categories were low (quintile 1), moderate (quintiles 2-3), and high (quintiles 4-5); standard cut points were used for adiposity exposures. Hazard ratios (HRs) were estimated using Cox regression. During a mean follow-up period of 19.2 ± 10.3 years, 391 cardiovascular deaths occurred. HRs (95% confidence interval) for CVD in moderate and low CRF groups, using high CRF as the referent, were 1.87 (1.46-2.38) and 2.54 (1.93-3.35), respectively ( trend <0.001). HRs of obese women within each adiposity exposure were higher when compared with normal-weight women ( ≤ 0.03). Joint associations of CRF × adiposity showed a positive trend in CVD mortality across decreasing categories of CRF within each category of W:HT and % Fat, as well as within the normal and overweight BMI categories and the normal WC category ( ≤ 0.03 for each). Higher levels of CRF are associated with lower CVD mortality risk in women, and predict lower risk of CVD mortality in normal-weight women and in obese women. Using different measures of adiposity to predict CVD mortality risk in women may be misleading unless CRF is taken into account. These results support the American Heart Association (AHA) recommendation for including CRF as a clinical vital sign.
心肺适能（CRF）与不同肥胖暴露因素对女性心血管疾病（CVD）死亡率的关联尚不清楚。共有 19838 名女性于 1971 年至 2013 年间完成了基线检查。检查项目包括体重指数（BMI）、腰围（WC）、腰高比（W:HT）、皮褶厚度衍生体脂百分比（%Fat）和通过最大跑步机测试估计的 CRF。CRF 分为低（五分位 1）、中（五分位 2-3）和高（五分位 4-5）；使用标准切点来衡量肥胖暴露因素。使用 Cox 回归估计风险比（HRs）。在平均 19.2±10.3 年的随访期间，发生了 391 例心血管死亡。以高 CRF 为参照，中低 CRF 组发生 CVD 的 HR（95%置信区间）分别为 1.87（1.46-2.38）和 2.54（1.93-3.35）（趋势<0.001）。在每个肥胖暴露因素中，肥胖女性的 HR 均高于正常体重女性（ ≤ 0.03）。CRF 与肥胖的联合作用表明，在 W:HT 和 %Fat 各分类中 CRF 水平逐渐降低的情况下，以及在正常体重 BMI 分类和正常 WC 分类中，CVD 死亡率的风险呈正相关趋势（ ≤ 0.03）。更高水平的 CRF 与女性 CVD 死亡率风险降低相关，并且在正常体重女性和肥胖女性中预测 CVD 死亡率风险降低。如果不考虑 CRF，则使用不同的肥胖测量方法来预测女性 CVD 死亡率风险可能会产生误导。这些结果支持美国心脏协会（AHA）的建议，将 CRF 作为临床生命体征纳入。
