Body weight and physical fitness in women with ischaemic heart disease: does physical fitness contribute to our understanding of the obesity paradox in women?

• Type of Material: Article
• Authors: Odayme Quesada, Cedars-Sinai Medical Center; Marie Lauzon, Cedars-Sinai Medical Center; Rae Buttle, Cedars-Sinai Medical Center; Janet Wei, Cedars-Sinai Medical Center; Nissi Suppogu, Cedars-Sinai Medical Center; Sheryl F Kelsey, University of Pittsburgh; Steven E Reis, University of Pittsburgh; Leslee Shaw, Emory University; George Sopko, National Institutes of Health, Bethesda; Eileen Handberg, University of Florida; Carl J Pepine, University of Florida; Noel C Bairey Merz, Cedars-Sinai Medical Center
• Language: English
• Date: 2022-09-07
• Publisher: SAGE Publications
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1093/eurjpc/zwac046
• Title of Journal or Parent Work: European Journal of Preventive Cardiology
• Volume: 29
• Issue: 12
• Start Page: 1608
• End Page: 1614
• Grant/Funding Information: This work is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute, the National Institutes of Health, or the U.S. Department of Health and Human Services.; This work was supported by contracts from the National Heart, Lung and Blood Institutes nos. N01-HV-68161, N01-HV-68162, N01-HV-68163, N01-HV-68164, grants T32HL116273, K23HL151867, U0164829, U01 HL649141, U01 HL649241, K23HL105787, T32HL69751, R01 HL090957, U54 AG065141, and 1R03AG032631 from the National Institute on Aging, GCRC grant MO1-RR00425 from the National Center for Research Resources, the National Center for Advancing Translational Sciences Grant UL1TR000124, and grants from the Gustavus and Louis Pfeiffer Research Foundation, Danville, NJ, the Women’s Guild of Cedars-Sinai Medical Center, Los Angeles, CA, the Ladies Hospital Aid Society of Western Pennsylvania, Pittsburgh, PA, and QMED, Inc., Laurence Harbor, NJ, the Edythe L. Broad and the Constance Austin Women’s Heart Research Fellowships, Cedars-Sinai Medical Center, Los Angeles, CA, the Barbra Streisand Women’s Cardiovascular Research and Education Program, Cedars-Sinai Medical Center, Los Angeles, the Society for Women’s Health Research (SWHR), Washington, DC, the Linda Joy Pollin Women’s Heart Health Program, the Erika Glazer Women’s Heart Health Project, and the Adelson Family Foundation, Cedars-Sinai Medical Center, Los Angeles, CA.
• Keywords: Women; Obesity; Physical fitness; Overweight; Cardiovascular disease; Mortality

Abstract

Aims Body mass index (BMI) defined obesity is paradoxically associated with lower all-cause mortality in patients with known cardiovascular disease. This study aims to determine the role of physical fitness in the obesity paradox in women with ischaemic heart disease (IHD). Methods and Results Women undergoing invasive coronary angiography with signs/symptoms of IHD in the Women’s Ischemia Syndrome Evaluation (WISE) prospective cohort (enrolled 1997–2001) were analysed. This study investigated the longer-term risk of major adverse cardiovascular events (MACE) and all-cause mortality associated with BMI and physical fitness measured by Duke Activity Status Index (DASI). Overweight was defined as BMl ≥25 to 30 kg/m2, obese as BMI ≥30 kg/m2, unfit as DASI scores <25, equivalent to ≤7 metabolic equivalents. Among 899 women, 18.6% were normal BMI-fit, 11.4% overweight-fit, 10.4% obese-fit, 15.3% normal BMI-unfit, 23.8% overweight-unfit, and 30.4% obese-unfit. In adjusted models compared to normal BMI-fit, normal BMI-unfit women had higher MACE risk [hazard ratio (HR) 1.65, 95% confidence interval (CI) 1.17–2.32; P = 0.004]; whereas obese-fit and overweight-fit women had lower risk of mortality (HR 0.60, 95% CI 0.40–0.89; P = 0.012 and HR 0.62, 95% CI 0.41–0.92; P = 0.018, respectively). Conclusion To address the paradox of body weight and outcomes in women, we report for the first time that among women with signs/symptoms of IHD overweight-fit and obese-fit were at lower risk of long-term all-cause mortality; whereas normal BMI-unfit were at higher risk of MACE. Physical fitness may contribute to the obesity paradox in women, warranting future studies to better understand associations between body weight, body composition, and physical fitness to improve cardiovascular outcomes in women.