ORIGINAL ARTICLEObesity Paradox and Cardiorespiratory Fitness in 12,417 Male Veterans Aged 40 to 70 Years
Section snippets
PATIENTS AND METHODS
VETS is an ongoing, prospective epidemiological investigation of veteran patients that began in 1983. All patients are referred for exercise testing either as a routine evaluation or as an evaluation for exercise-induced ischemia. Participants in the current study were drawn from a cohort of 15,660 male veterans (excluding patients with a history of implanted pacemaker, those who developed left bundle-branch block during the test, and those who were clinically unstable or required emergent
RESULTS
During a mean ± SD follow-up of 7.7±5.3 years (range, 0.08-22.92 years), 2801 deaths were recorded. Baseline characteristics grouped according to BMI category are presented in Table 1. The study population consisted of 6982 (56.2%) white and 5435 (43.8%) African American men who ranged in age from 40 to 70 years. There were 137 underweight patients (1.1%), 2885 normal-weight (23.2%), 5187 overweight (41.8%), and 4208 obese (33.9%) (2893 obese I [23.3%], 947 obese II [7.6%], and 368 obese III
DISCUSSION
In multivariate analyses, both fitness and BMI were independently and inversely associated with mortality risk. To ascertain whether low BMI resulted from undetected illness at baseline, we excluded all patients who died during the first 2 years of follow-up and current smokers, but this did not substantially change the primary findings. In joint analyses, elevated BMI generally reduced mortality risk within each fitness category, and higher levels of fitness decreased mortality risk within
CONCLUSION
Both higher BMI and higher fitness were protective for all-cause mortality in this cohort of white and African American middle-aged male veterans with known or suspected CVD. Fitness altered the obesity paradox such that overweight and obese men had increased longevity only if they registered high fitness. Future studies should focus on the influence of fitness and BMI on mortality in diverse populations and whether changes in fitness level and/or body weight affect health outcomes.
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