Relationship between low cardiorespiratory fitness and mortality in normal-weight, overweight, and obese men
Relationship between low cardiorespiratory fitness and mortality in normal-weight, overweight, and obese men
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DOI：
10.1001/jama.282.16.1547
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发表时间：
1999-10-27
影响因子：
120.7
通讯作者：
Blair, SN
中科院分区：
文献类型：
--
作者：
Wei, M;Kampert, JB;Blair, SN
背景超重和肥胖治疗的最新指南包括根据疾病状况和心血管疾病（CVD）危险因素进行危险分层的建议，但在这些建议中，缺乏体力活动的作用并不突出。目的量化低心肺功能（一种缺乏体力活动的客观标志）对正常体重、超重、肥胖和高血压患者的CVD和全因死亡率的影响。研究设计：来自有氧运动中心纵向研究的前瞻性观察数据，地点：德克萨斯州达拉斯的预防医学诊所。（平均年龄，43.8岁[SD，10.1岁]），在1970年至1993年期间接受医学检查，死亡率随访至1994年12月31日，主要指标心血管疾病和基于死亡预测因子的全因死亡率（基线CVD、2型糖尿病、高血清胆固醇水平、高血压、目前吸烟，结果在研究期间，有1025人死亡（439人死于心血管疾病），在258781人年的随访。超重和肥胖的男性与基线CVD或CVD危险因素相比，在所有原因和CVD死亡的风险较高的体重正常的男性没有这些预测因素。以无心血管疾病的正常体重男性为参照，肥胖男性心血管疾病死亡的最强预测因子是基线心血管疾病（年龄和检查年调整的相对危险度[RR]，14.0; 95%置信区间[CI]，9.4 - 20.8）;对于患有糖尿病、高胆固醇、高血压、吸烟和低健康的肥胖男性，RR相似，范围为4.4（95% CI，2.7 - 7.1）吸烟至5.0（95% CI，3.6 - 7.0）低健身。肥胖男性全因死亡的相对风险范围为2.3（95%CI，1.7 - 2.9）（高血压男性）至4.7（95%CI，3.6 - 6.1）（基线时CVD男性）。低健康的肥胖男性全因死亡的相对危险度为3.1（95%CI，2.5 - 3.8），糖尿病肥胖男性为3.1（95%CI，2.3 - 4.2），略高于吸烟或胆固醇水平高的肥胖男性的RR。在调整其他死亡率预测因素后，低体能是所有体重指数组死亡率的独立预测因素。大约50%（n = 1674）的肥胖男性有低适应性，这导致人群归因于CVD死亡率为39%，全因死亡率为44%。基线心血管疾病的人群归因风险为51%和27%的心血管疾病和全因mortality，foreign.Conclusions在这项分析中，低心肺功能是一个强大的和独立的预测心血管疾病和全因死亡率和糖尿病和其他心血管疾病的危险因素的重要性相当。
Context Recent guidelines for treatment of overweight and obesity include recommendations for risk stratification by disease conditions and cardiovascular disease (CVD) risk factors, but the role of physical inactivity is not prominent in these recommendations.Objective To quantify the influence of low cardiorespiratory fitness, an objective marker of physical inactivity, on CVD and all-cause mortality in normal-weight, overweight, and obese men and compare low fitness with other mortality predictors.Design Prospective observational data from the Aerobics Center Longitudinal Study.Setting Preventive medicine clinic in Dallas, Tex.Participants A total of 25 714 adult men (average age, 43.8 years [SD, 10.1 years]) who received a medical examination during 1970 to 1993, with mortality follow-up to December 31, 1994,Main Outcome Measures Cardiovascular disease and all-cause mortality based on mortality predictors (baseline CVD, type 2 diabetes mellitus, high serum cholesterol level, hypertension, current cigarette smoking, and low cardiorespiratory fitness) stratified by body mass index.Results During the study period, there were 1025 deaths (439 due to CVD) during 258 781 man-years of follow up. Overweight and obese men with baseline CVD or CVD risk factors were at higher risk for all-cause and CVD mortality compared with normal-weight men without these predictors. Using normal-weight men without CVD as the referent, the strongest predictor of CVD death in obese men was baseline CVD (age- and examination year-adjusted relative risk [RR], 14.0; 95% confidence interval [CI], 9.4-20.8); RRs for obese men with diabetes mellitus, high cholesterol, hypertension, smoking, and low fitness were similar and ranged from 4.4 (95% CI, 2.7-7.1) for smoking to 5.0 (95% CI, 3.6-7.0) for low fitness. Relative risks for all-cause mortality in obese men ranged from 2.3 (95% CI, 1.7-2.9) for men with hypertension to 4.7 (95% CI, 3.6-6.1) for those with CVD at baseline. Relative risk for all-cause mortality in obese men with low fitness was 3.1 (95% CI, 2.5-3.8) and in obese men with diabetes mellitus 3.1 (95 % CI, 2.3-4.2) and as slightly higher than the RRs for obese men who smoked or had high cholesterol levels. Low fitness was an independent predictor of mortality in all body mass index groups after adjustment for other mortality predictors. Approximately 50% (n = 1674) of obese men had low fitness, which led to a population-attributable risk of 39% for CVD mortality and 44% for all-cause mortality. Baseline CVD had population attributable risks of 51% and 27% for CVD and all-cause mortality, respectively.Conclusions In this analysis, low cardiorespiratory fitness was a strong and independent predictor of CVD and all-cause mortality and of comparable importance with that of diabetes mellitus and other CVD risk factors.