Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ.
Med Sci Sports Exerc. 2022 Jun 1;54(6):994-1001. doi: 10.1249/MSS.0000000000002873. Epub 2022 Feb 15.
We estimated the effects of cardiorespiratory fitness (CRF) and body mass index (BMI) at baseline on mortality and cardiovascular disease events in people with type 2 diabetes who participated in the Look AHEAD randomized clinical trial.
Look AHEAD compared effects of an intensive lifestyle intervention with diabetes support and education on cardiovascular disease events in 5145 adults age 45-76 yr with overweight/obesity and type 2 diabetes. In 4773 participants, we performed a secondary analysis of the association of baseline CRF during maximal treadmill test (expressed as metabolic equivalents (METs)) on mortality and cardiovascular disease events during a mean follow-up of 9.2 yr.
The mean (SD) CRF was 7.2 (2.0) METs. Adjusted for age, sex, race/ethnicity, BMI, intervention group, and β-blocker use, all-cause mortality rate was 30% lower per SD greater METs (hazard ratio (HR) = 0.70 (95% confidence interval, 0.60 to 0.81); rate difference (RD), -2.71 deaths/1000 person-years (95% confidence interval, -3.79 to -1.63)). Similarly, an SD greater METs predicted lower cardiovascular disease mortality (HR, 0.45; RD, -1.65 cases/1000 person-years) and a composite cardiovascular outcome (HR, 0.72; RD, -6.38). Effects of METs were homogeneous on the HR scale for most baseline variables and outcomes but heterogeneous for many on the RD scale, with greater RD in subgroups at greater risk of the outcomes. For example, all-cause mortality was lower by 7.6 deaths/1000 person-years per SD greater METs in those with a history of cardiovascular disease at baseline but lower by only 1.6 in those without such history. BMI adjusted for CRF had little or no effect on these outcomes.
Greater CRF is associated with reduced risks of mortality and cardiovascular disease events.
我们评估了基线时心肺适能（CRF）和体重指数（BMI）对参加 LOOK AHEAD 随机临床试验的 2 型糖尿病患者死亡率和心血管疾病事件的影响。
LOOK AHEAD 比较了强化生活方式干预与糖尿病支持和教育对 5145 名年龄在 45-76 岁、超重/肥胖和 2 型糖尿病患者心血管疾病事件的影响。在 4773 名参与者中，我们对基线时最大跑步机测试期间的 CRF（表示为代谢当量（METs））与平均随访 9.2 年后的死亡率和心血管疾病事件之间的关联进行了二次分析。
平均（SD）CRF 为 7.2（2.0）METs。调整年龄、性别、种族/民族、BMI、干预组和β受体阻滞剂使用后，每增加 1 个 SD 的 METs，全因死亡率降低 30%（风险比（HR）=0.70（95%置信区间，0.60 至 0.81）；率差（RD），-2.71 例/1000 人年（95%置信区间，-3.79 至-1.63））。同样，更大的 METs 预测心血管疾病死亡率（HR，0.45；RD，-1.65 例/1000 人年）和复合心血管结局（HR，0.72；RD，-6.38）降低。METs 的效应在大多数基线变量和结局的 HR 尺度上是同质的，但在 RD 尺度上是异质的，在结局风险较高的亚组中 RD 更大。例如，在基线时有心血管疾病史的患者，每增加 1 个 SD 的 METs，全因死亡率降低 7.6 例/1000 人年，但无此类病史的患者仅降低 1.6 例/1000 人年。调整 CRF 后的 BMI 对这些结局几乎没有影响。
更高的 CRF 与降低死亡率和心血管疾病事件的风险相关。
