Jae Sae Young, Kim Hyun Jeong, Lee Kyung Hyun, Kunutsor Setor K, Heffernan Kevin S, Choi Yoon-Ho, Kang Mira
Department of Sport Science, University of Seoul, Seoul, South Korea (Drs Jae and Kim); Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (Mr Lee and Drs Choi and Kang); National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK (Dr Kunutsor); Translational Health Sciences, Bristol Medical School, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol, UK (Dr Kunutsor); Department of Exercise Science, Syracuse University, Syracuse, New York (Dr Heffernan); and Division of Urban Social Health, Graduate School of Urban Public Health, University of Seoul, Seoul, South Korea (Dr Jae).
J Cardiopulm Rehabil Prev. 2022 May 1;42(3):202-207. doi: 10.1097/HCR.0000000000000631. Epub 2022 Feb 8.
The purpose of this study was to examine the individual and joint associations of obesity and cardiorespiratory fitness (CRF) with indices of coronary artery calcification (CAC) in 2090 middle-aged men.
Obesity was defined as a body mass index (BMI) ≥25 kg/m2 and a waist circumference (WC) ≥90 cm. Cardiorespiratory fitness was operationally defined as peak oxygen uptake (V˙o2peak) directly measured using gas analysis. Participants were then divided into unfit and fit categories based on age-specific V˙o2peak percentiles. Agatston scores >100 and volume and density scores >75th percentile were defined as indices of CAC, signifying advanced subclinical atherosclerosis.
Obese men had increased CAC Agatston, volume, and density scores, while higher CRF was associated with lower Agatston and volume scores after adjusting for potential confounders. In the joint analysis, unfit-obese men had higher CAC Agatston and CAC volume. The fit-obesity category was not associated with CAC Agatston (OR = 0.91: 95% CI, 0.66-1.25, for BMI and OR = 1.21: 95% CI, 0.86-1.70, for WC) and CAC volume (OR = 1.14: 95% CI, 0.85-1.53, for BMI and OR = 1.23: 95% CI, 0.90-1.69, for WC), which were similar to estimates for the fit-normal weight category.
These findings demonstrate that while obesity is positively associated with the prevalence of moderate to severe CAC scores, CRF is inversely associated with the prevalence of moderate to severe CAC scores. Additionally, the combination of being fit and obese was not associated with CAC scores, which could potentially reinforce the fat-but-fit paradigm.
本研究旨在探讨2090名中年男性中肥胖与心肺适能（CRF）分别及共同与冠状动脉钙化（CAC）指标之间的关联。
肥胖定义为体重指数（BMI）≥25 kg/m²且腰围（WC）≥90 cm。心肺适能在操作上定义为使用气体分析直接测量的峰值摄氧量（V˙o2peak）。然后根据特定年龄的V˙o2peak百分位数将参与者分为不适能和适能类别。阿加斯顿评分>100以及体积和密度评分>第75百分位数被定义为CAC指标，表明存在晚期亚临床动脉粥样硬化。
肥胖男性的CAC阿加斯顿、体积和密度评分升高，而在调整潜在混杂因素后，较高的CRF与较低的阿加斯顿和体积评分相关。在联合分析中，不适能-肥胖男性的CAC阿加斯顿和CAC体积较高。适能-肥胖类别与CAC阿加斯顿（BMI的OR = 0.91：95%CI，0.66 - 1.25，WC的OR = 1.21：95%CI，0.86 - 1.70）和CAC体积（BMI的OR = 1.14：95%CI，0.85 - 1.53，WC的OR = 1.23：95%CI，0.90 - 1.69）无关，这与适能-正常体重类别的估计值相似。
这些发现表明，虽然肥胖与中度至重度CAC评分的患病率呈正相关，但CRF与中度至重度CAC评分的患病率呈负相关。此外，适能且肥胖的组合与CAC评分无关，这可能会强化“胖但健康”的模式。
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