Cardiorespiratory Fitness, BMI, Mortality, and Cardiovascular Disease in Adults with Overweight/Obesity and Type 2 Diabetes.
Cardiorespiratory Fitness, BMI, Mortality, and Cardiovascular Disease in Adults with Overweight/Obesity and Type 2 Diabetes.
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DOI：
10.1249/mss.0000000000002873
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发表时间：
2022-06-01
影响因子：
4.1
通讯作者：
Knowler, William C.
中科院分区：
文献类型：
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作者：
Wills, Andrew C.;Arreola, Elsa Vazquez;Olaiya, Muideen T.;Curtis, Jeffrey M.;Hellgren, Margareta I.;Hanson, Robert L.;Knowler, William C.
我们评估了参与前瞻性随机临床试验的2型糖尿病患者基线时心肺适能（CRF）和体重指数（BMI）对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5，145名45-76岁超重/肥胖和2型糖尿病成人心血管疾病事件的影响。在4，773名参与者中，我们对最大跑步机试验（以代谢当量（MET）表示）期间基线CRF与平均随访9.2年期间死亡率和心血管疾病事件的相关性进行了次要分析。平均（SD）CRF为7.2（2.0）MET。根据年龄、性别、人种/种族、体重指数、干预组和β受体阻滞剂使用进行调整后，每SD较大MET的全因死亡率降低30%（风险比，HR=0.70，95% CI 0.60-0.81;率差，RD=-2.71例死亡/1000人-年，95% CI-3.79至-1.63）。同样，MET值越高，预测心血管疾病死亡率越低（HR=0.45，RD =-1.65例/1000人-年），复合心血管结局越低（HR= 0.72; RD=-6.38）。对于大多数基线变量和结局，MET对HR量表的影响是同质的，但对于RD量表的许多影响是异质的，在结局风险更高的亚组中RD更大。例如，在基线时有心血管疾病史的患者中，全因死亡率每SD更大的MET降低7.6例死亡/1000人-年，但在无心血管疾病史的患者中仅降低1.6例。经CRF校正的BMI对这些结果影响很小或没有影响。CRF越大，死亡率和心血管疾病事件的风险越低。
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 that 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 5,145 adults aged 45–76 years with overweight/obesity and type 2 diabetes. In 4,773 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 mean follow-up of 9.2 years. The mean (SD) CRF was 7.2 (2.0) METs. Adjusted for age, sex, race/ethnicity, body mass index, intervention group, and β-blocker use, all-cause mortality rate was 30% lower per SD greater METs (hazard ratio, HR=0.70, 95% CI 0.60–0.81; rate difference, RD=−2.71 deaths/1000 person-years, 95% CI −3.79 to −1.63). Similarly, a 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 RDs 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.