Fitness attenuates long-term cardiovascular outcomes in women with ischemic heart disease and metabolic syndrome

• Type of Material: Article
• Authors: Leslee Shaw, Emory University; Odayme Quesada, The Christ Hospital, Cincinnati; Marie Louzon, Cedars-Sinai Medical Center; Rae Buttle, Cedars-Sinai Medical Center; Janet Wei, Cedars-Sinai Medical Center; Nissi Suppogu, Cedars-Sinai Medical Center; Galen Cook-Wiens, Cedars-Sinai Medical Center; Steven E Reis, University of Pittsburgh; George Sopko, National Institutes of Health, Bethesda; Eileen Handberg, University of Florida; Carl J Pepine, University of Florida, Gainesville; Noel Bairey C Merz, Cedars-Sinai Medical Center
• Language: English
• Date: 2023-06-01
• Publisher: Elsevier B.V.
• Publication Version: Final Published Version
• Copyright Statement: © 2023 The Authors. Published by Elsevier B.V.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ajpc.2023.100498
• Title of Journal or Parent Work: American Journal of Preventive Cardiology
• Volume: 14
• Grant/Funding Information: This work was also supported by grants from the Gustavus and Louis Pfeiffer Research Foundation, Danville, NJ; The Ladies Hospital Aid Society of Western Pennsylvania, Pittsburgh, PA; The Society for Women's Health Research (SWHR), Washington, D.C.; QMED, Inc., Laurence Harbor, NJ; The Women's Guild of Cedars-Sinai, the Edythe L. Broad, the Constance Austin Women's Heart Research Fellowships, the Barbra Streisand Women's Cardiovascular Research and Education Program, the Linda Joy Pollin Women's Heart Health Program, the Erika J. Glazer Women's Heart Research Initiative, and The Adelson Family Foundation, Cedars-Sinai Medical Center, Los Angeles, CA; the Gatorade Trust and the PCORnet-One Florida Clinical Research Consortium CDRN-1501-26692, University of Florida, Gainesville, FL.; This research was supported by the National Heart, Lung and Blood Institute (NHLBI) under grant numbers N01HV68161, N01HV68162, N01HV68163, N01HV68164, U01HL64829, U01HL64914, U01HL64924, K23HL105787, K23HL127262, K23HL151867, T32HL69751, T32HL116273, R01HL090957, R01HL33610, R01HL56921, and UM1HL087366; the National Institute on Aging (NIA) under grant number R03AG032631; the National Center for Research Resources (NCRR) under grant number M01RR000425; the National Center for Advancing Translational Sciences (NCATS) under grant numbers UL1TR000124, UL1TR000064, UL1TR001427
• Keywords: Fitness; Metabolic syndrome; Diabetes; Cardiovascular risk
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Background The prevalence of metabolic syndrome continues to increase steadily while fitness remains relatively low. The contribution of fitness on longer-term cardiovascular outcomes and mortality in individuals with cardiovascular disease and metabolic syndrome remains unknown. Design Women's Ischemia Syndrome Evaluation (WISE) prospective cohort (enrolled 1996–2001) of women undergoing invasive coronary angiography with signs/symptoms of ischemic heart disease. Methods Investigated the association of fitness, defined as >7METs measured by self-reported Duke Activity Status Index (DASI), and both metabolic syndrome (ATPIII criteria) and dysmetabolism (ATPIII criteria and/or treated diabetes) with long-term cardiovascular outcomes and all-cause mortality risk. Results Among the 492 women followed for a median of 8.6 years (range 0–11 years), 19.5% were fit-metabolically healthy (reference), 14.4% fit-metabolic syndrome, 29.9% unfit-metabolically healthy, and 36.2% unfit-metabolic syndrome. Compared to reference, MACE risk was 1.52-fold higher in fit-metabolic syndrome women (HR 1.52, 95% CI 1.03–2.26) and 2.42-fold higher in unfit-metabolic syndrome women (HR 2.42, 95% CI 1.30–4.48). Compared to reference, mortality risk was 1.96-fold higher in fit-dysmetabolism (HR 1.96, 95% CI 1.29–3.00) and 3-fold higher in unfit-dysmetabolism women (HR 3.0, 95% CI 1.66–5.43). Conclusions In a high risk cohort of women with signs/symptoms of ischemic heart disease, unfit-metabolically healthy and fit-metabolically unhealthy women were at higher risk of long-term MACE and mortality compared to fit-metabolically healthy women; and women who were unfit and metabolically unhealthy were at the highest risk. Our study demonstrates that metabolic health and fitness play an important role in long term outcomes that warrants further investigation.