Interactive effects of obesity and physical fitness on risk of ischemic heart disease

C Crump, J Sundquist, M A Winkleby, K Sundquist, C Crump, J Sundquist, M A Winkleby, K Sundquist

Abstract

Background/objectives: Obesity and low physical fitness are known risk factors for ischemic heart disease (IHD), but their interactive effects are unclear. Elucidation of interactions between these common, modifiable risk factors may help inform more effective preventive strategies. We examined interactive effects of obesity, aerobic fitness and muscular strength in late adolescence on risk of IHD in adulthood in a large national cohort.

Subjects/methods: We conducted a national cohort study of all 1 547 407 military conscripts in Sweden during 1969-1997 (97-98% of all 18-year-old males each year). Aerobic fitness, muscular strength and body mass index (BMI) measurements were examined in relation to IHD identified from outpatient and inpatient diagnoses through 2012 (maximum age 62 years).

Results: There were 38 142 men diagnosed with IHD in 39.7 million person years of follow-up. High BMI or low aerobic fitness (but not muscular strength) was associated with higher risk of IHD, adjusting for family history and socioeconomic factors. The combination of high BMI (overweight/obese vs normal) and low aerobic fitness (lowest vs highest tertile) was associated with highest IHD risk (incidence rate ratio, 3.11; 95% confidence interval (CI), 2.91-3.31; P<0.001). These exposures had no additive and a negative multiplicative interaction (that is, their combined effect was less than the product of their separate effects). Low aerobic fitness was a strong risk factor even among those with normal BMI.

Conclusions: In this large cohort study, low aerobic fitness or high BMI at age 18 was associated with higher risk of IHD in adulthood, with a negative multiplicative interaction. Low aerobic fitness appeared to account for a similar number of IHD cases among those with normal vs high BMI (that is, no additive interaction). These findings suggest that interventions to prevent IHD should begin early in life and include not only weight control but aerobic fitness, even among persons of normal weight.

Conflict of interest statement

None.

Figures

Figure 1
Figure 1
Probability of IHD by aerobic fitness and BMI in 18-year-old men with mean follow-up of 25.7 years (maximum age 62 years).

References

    1. Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, De Simone G, et al. Executive summary: heart disease and stroke statistics--2010 update: a report from the American Heart Association. Circulation. 2010;121(7):948–54.
    1. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, et al. Executive summary: heart disease and stroke statistics--2014 update: a report from the American Heart Association. Circulation. 2014;129(3):399–410.
    1. Andersen LG, Angquist L, Eriksson JG, Forsen T, Gamborg M, Osmond C, et al. Birth weight, childhood body mass index and risk of coronary heart disease in adults: combined historical cohort studies. PLoS One. 2010;5(11):e14126.
    1. Baker JL, Olsen LW, Sorensen TI. Childhood body-mass index and the risk of coronary heart disease in adulthood. N Engl J Med. 2007;357(23):2329–37.
    1. Owen CG, Whincup PH, Orfei L, Chou QA, Rudnicka AR, Wathern AK, et al. Is body mass index before middle age related to coronary heart disease risk in later life? Evidence from observational studies. Int J Obes (Lond) 2009;33(8):866–77.
    1. Falkstedt D, Hemmingsson T, Rasmussen F, Lundberg I. Body mass index in late adolescence and its association with coronary heart disease and stroke in middle age among Swedish men. Int J Obes (Lond) 2007;31(5):777–83.
    1. Osler M, Lund R, Kriegbaum M, Andersen AM. The influence of birth weight and body mass in early adulthood on early coronary heart disease risk among Danish men born in 1953. Eur J Epidemiol. 2009;24(1):57–61.
    1. Yang L, Kuper H, Weiderpass E. Anthropometric characteristics as predictors of coronary heart disease in women. J Intern Med. 2008;264(1):39–49.
    1. Bergh C, Udumyan R, Fall K, Almroth H, Montgomery S. Stress resilience and physical fitness in adolescence and risk of coronary heart disease in middle age. Heart. 2015;101(8):623–9.
    1. Hogstrom G, Nordstrom A, Nordstrom P. High aerobic fitness in late adolescence is associated with a reduced risk of myocardial infarction later in life: a nationwide cohort study in men. Eur Heart J. 2014;35(44):3133–40.
    1. Andersen K, Rasmussen F, Held C, Neovius M, Tynelius P, Sundstrom J. Exercise capacity and muscle strength and risk of vascular disease and arrhythmia in 1. 1 million young Swedish men: cohort study. BMJ. 2015;351:h4543.
    1. Kodama S, Saito K, Tanaka S, Maki M, Yachi Y, Asumi M, et al. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA. 2009;301(19):2024–35.
    1. Li TY, Rana JS, Manson JE, Willett WC, Stampfer MJ, Colditz GA, et al. Obesity as compared with physical activity in predicting risk of coronary heart disease in women. Circulation. 2006;113(4):499–506.
    1. Weinstein AR, Sesso HD, Lee IM, Rexrode KM, Cook NR, Manson JE, et al. The joint effects of physical activity and body mass index on coronary heart disease risk in women. Arch Intern Med. 2008;168(8):884–90.
    1. Hu G, Tuomilehto J, Silventoinen K, Barengo NC, Peltonen M, Jousilahti P. The effects of physical activity and body mass index on cardiovascular, cancer and all-cause mortality among 47 212 middle-aged Finnish men and women. Int J Obes (Lond) 2005;29(8):894–902.
    1. Crump C, Sundquist J, Winkleby MA, Sundquist K. Interactive Effects of Physical Fitness and Body Mass Index on the Risk of Hypertension. JAMA Intern Med. 2016;176(2):210–6.
    1. Crump C, Sundquist J, Winkleby MA, Sieh W, Sundquist K. Physical Fitness Among Swedish Military Conscripts and Long-Term Risk for Type 2 Diabetes Mellitus: A Cohort Study. Ann Intern Med. 2016;164(9):577–84.
    1. Crump C, Sundquist J, Winkleby MA, Sundquist K. Interactive effects of physical fitness and body mass index on risk of stroke: A national cohort study. Int J Stroke. 2016;11(6):683–94.
    1. Nordesjo L, Schele R. Validity of an ergometer cycle test and measures of isometric muscle strength when predicting some aspects of military performance. Swedish J Defence Med. 1974;10:11–23.
    1. Patton JF, Vogel JA, Mello RP. Evaluation of a maximal predictive cycle ergometer test of aerobic power. European journal of applied physiology and occupational physiology. 1982;49(1):131–140.
    1. Andersen LB. A maximal cycle exercise protocol to predict maximal oxygen uptake. Scand J Med Sci Sports. 1995;5(3):143–6.
    1. Hook O, Tornvall G. Apparatus and method for determination of isometric muscle strength in man. Scand J Rehabil Med. 1969;1:139–142.
    1. Ogden CL, Flegal KM. Changes in terminology for childhood overweight and obesity. Natl Health Stat Report. 2010;(25):1–5.
    1. Ludvigsson JF, Andersson E, Ekbom A, Feychting M, Kim JL, Reuterwall C, et al. External review and validation of the Swedish national inpatient register. BMC Public Health. 2011;11:450.
    1. Diez Roux AV, Merkin SS, Arnett D, Chambless L, Massing M, Nieto FJ, et al. Neighborhood of residence and incidence of coronary heart disease. N Engl J Med. 2001;345(2):99–106.
    1. Winkleby M, Sundquist K, Cubbin C. Inequities in CHD incidence and case fatality by neighborhood deprivation. Am J Prev Med. 2007;32(2):97–106.
    1. Stoddard PJ, Laraia BA, Warton EM, Moffet HH, Adler NE, Schillinger D, et al. Neighborhood deprivation and change in BMI among adults with type 2 diabetes: the Diabetes Study of Northern California (DISTANCE) Diabetes Care. 2013;36(5):1200–8.
    1. Crump C, Sundquist K, Sundquist J, Winkleby MA. Neighborhood deprivation and psychiatric medication prescription: a Swedish national multilevel study. Ann Epidemiol. 2011;21(4):231–7.
    1. Rubin DB. Multiple Imputation for Nonresponse in Surveys. Wiley; New York: 1987.
    1. Zou G. A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159(7):702–6.
    1. Li R, Chambless L. Test for additive interaction in proportional hazards models. Ann Epidemiol. 2007;17(3):227–36.
    1. Orsini N, Bellocco R, Bottai M, Wolk A, Greenland S. A tool for deterministic and probabilistic sensitivity analysis of epidemiologic studies. The Stata Journal. 2008;8(1):29–48.
    1. Furberg H, Lichtenstein P, Pedersen NL, Bulik C, Sullivan PF. Cigarettes and oral snuff use in Sweden: Prevalence and transitions. Addiction. 2006;101(10):1509–15.
    1. Njolstad I, Arnesen E, Lund-Larsen PG. Smoking, serum lipids, blood pressure, and sex differences in myocardial infarction. A 12-year follow-up of the Finnmark Study. Circulation. 1996;93(3):450–6.
    1. Prescott E, Hippe M, Schnohr P, Hein HO, Vestbo J. Smoking and risk of myocardial infarction in women and men: longitudinal population study. BMJ. 1998;316(7137):1043–7.
    1. StataCorp. Stata Statistical Software: Release 14. StataCorp LP; College Station, TX: 2014.
    1. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384(9945):766–81.
    1. Hallal PC, Andersen LB, Bull FC, Guthold R, Haskell W, Ekelund U, et al. Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet. 2012;380(9838):247–57.
    1. Global Burden of Disease and Risk Factors Collaborators. Forouzanfar MH, Alexander L, Anderson HR, Bachman VF, Biryukov S, et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386(10010):2287–323.
    1. Knol MJ, Egger M, Scott P, Geerlings MI, Vandenbroucke JP. When one depends on the other: reporting of interaction in case-control and cohort studies. Epidemiology. 2009;20(2):161–6.
    1. Greenland S. Interactions in epidemiology: relevance, identification, and estimation. Epidemiology. 2009;20(1):14–7.
    1. Owen CG, Kapetanakis VV, Rudnicka AR, Wathern AK, Lennon L, Papacosta O, et al. Body mass index in early and middle adult life: prospective associations with myocardial infarction, stroke and diabetes over a 30-year period: the British Regional Heart Study. BMJ Open. 2015;5(9):e008105.
    1. Crump C, Sundquist J, Winkleby MA, Sieh W, Sundquist K. Physical Fitness Among Swedish Military Conscripts and Long-Term Risk for Type 2 Diabetes Mellitus: A Cohort Study. Ann Intern Med. 2016
    1. Jurca R, Lamonte MJ, Barlow CE, Kampert JB, Church TS, Blair SN. Association of muscular strength with incidence of metabolic syndrome in men. Med Sci Sports Exerc. 2005;37(11):1849–55.
    1. Wijndaele K, Duvigneaud N, Matton L, Duquet W, Thomis M, Beunen G, et al. Muscular strength, aerobic fitness, and metabolic syndrome risk in Flemish adults. Med Sci Sports Exerc. 2007;39(2):233–40.
    1. Van Gaal LF, Mertens IL, De Block CE. Mechanisms linking obesity with cardiovascular disease. Nature. 2006;444(7121):875–80.
    1. Sandvik L, Erikssen J, Thaulow E, Erikssen G, Mundal R, Rodahl K. Physical fitness as a predictor of mortality among healthy, middle-aged Norwegian men. N Engl J Med. 1993;328(8):533–7.
    1. Diaz VA, Player MS, Mainous AG, 3rd, Carek PJ, Geesey ME. Competing impact of excess weight versus cardiorespiratory fitness on cardiovascular risk. Am J Cardiol. 2006;98(11):1468–71.
    1. Allison MA, Jensky NE, Marshall SJ, Bertoni AG, Cushman M. Sedentary behavior and adiposity-associated inflammation: the Multi-Ethnic Study of Atherosclerosis. Am J Prev Med. 2012;42(1):8–13.
    1. Rana JS, Arsenault BJ, Despres JP, Cote M, Talmud PJ, Ninio E, et al. Inflammatory biomarkers, physical activity, waist circumference, and risk of future coronary heart disease in healthy men and women. Eur Heart J. 2011;32(3):336–44.
    1. Swift DL, Lavie CJ, Johannsen NM, Arena R, Earnest CP, O’Keefe JH, et al. Physical activity, cardiorespiratory fitness, and exercise training in primary and secondary coronary prevention. Circ J. 2013;77(2):281–92.
    1. Sui X, LaMonte MJ, Blair SN. Cardiorespiratory fitness as a predictor of nonfatal cardiovascular events in asymptomatic women and men. Am J Epidemiol. 2007;165(12):1413–23.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj