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- W2068049389 abstract "Guidelines and recommendations for conventional coronary risk factors are widely available, as are clinically relevant threshold values for the treatment of hypertension, cholesterol and its subfractions, overweight/obesity, and impaired fasting glucose. Although increasing levels of physical activity and aerobic capacity (cardiorespiratory fitness) are widely believed to be cardioprotective, Williams1 reported that these variables have significantly different associations with cardiovascular disease. Regarding physical activity (independent of aerobic fitness), the risk of cardiovascular disease decreased linearly when plotted as a function of the cumulative percentages of the samples ranked from least active to most active (Figure). However, when analyzed according to aerobic fitness, there was a precipitous decrease in cardiovascular disease risk when comparing the lowest (0) to the next-lowest (ie, 25th percentile) fitness category. Beyond this demarcation in aerobic fitness category, the reductions in relative risk paralleled those observed with increasing physical activity alone. Accordingly, there was a 64% decrease in the risk of heart disease from the least to the most aerobically fit and a 30% decrease from the least to the most physically active. It was concluded that being unfit (the least fit cohort) warrants consideration as an independent risk factor for coronary heart disease and deserves screening and intervention.FIGURE.The risks of coronary heart disease and cardiovascular disease decrease linearly in association with increasing percentiles of physical activity. In contrast, there is a precipitous decrease in risk when comparing the lowest to the next-lowest category ...Numerous epidemiological studies in apparently healthy men and women, those with comorbid conditions (eg, overweight/obesity, hypertension, type 2 diabetes mellitus), and those with suspected or known coronary artery disease have now identified a low level of aerobic fitness, expressed as metabolic equivalents (METs; 1 MET = a whole-body oxygen consumption of 3.5 mL O2/kg/min), as an independent risk factor for all-cause and cardiovascular mortality.2-10 Low-fit participants were approximately 2 to 5 times more likely to die during follow-up compared with their more fit counterparts. The study by Lyerly et al,11 published in the current issue of Mayo Clinic Proceedings, extends these analyses to a cohort at increased risk of cardiovascular disease, that is, middle-aged women with impaired fasting glucose (100.0-125.9 mg/dL; to convert to mmol/L, multiply by 0.0555) or previously undiagnosed diabetes (fasting glucose ≥126 mg/dL), with specific reference to the modulating influence of overweight/obesity as reflected by body mass index (BMI; computed as weight in kilograms divided by height in meters squared).To evaluate the isolated and combined associations of aerobic fitness and BMI on the risk of mortality in women with impaired fasting glucose or undiagnosed diabetes, Lyerly et al conducted a retrospective analysis of data from the Aerobics Center Longitudinal Study of 3044 apparently healthy women (mean age, 47.4 years) who underwent preventive medical examinations, including a maximal treadmill exercise test (January 26, 1971-March 21, 2001). None of the study patients had previous cardiovascular events or a history of diabetes mellitus at baseline. Cardiorespiratory fitness was estimated from the attained speed, grade, and duration of maximal treadmill testing to volitional exhaustion or adverse signs/symptoms. Patients were categorized into age-adjusted low (bottom 20%), moderate (next 40%), or high (most fit 40%) groups.See also page 780During a mean follow-up of 15.6 years, 171 deaths were recorded. Those who died tended to be older, had lower levels of age-adjusted cardiorespiratory fitness, and were more likely to have major risk factors (ie, cigarette smoking, hypertension, hypercholesterolemia) compared with survivors. Accordingly, there was an inverse association between cardiorespiratory fitness, expressed as METs, and all-cause mortality, even after adjusting for potential confounding variables. An exercise capacity less than 7 METs was associated with a 1.5-fold higher risk of death compared with 9 or more METs (Ptrend=.05). Death rates in overweight/obese unfit (bottom 20%) women were more than double those in fit women (moderate and high cardiorespiratory fitness) with BMI of 25 kg/m2 or higher. In contrast, there was no association between overweight or obesity and overall deaths in this cohort of women with impaired fasting glucose or previously undiagnosed diabetes." @default.
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- W2068049389 date "2009-09-01" @default.
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- W2068049389 title "Cardiorespiratory fitness: an independent and additive marker of risk stratification and health outcomes." @default.
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- W2068049389 doi "https://doi.org/10.1016/s0025-6196(11)60486-2" @default.
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