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Relationship of Physical Fitness vs Body Mass Index With Coronary Artery Disease and Cardiovascular Events in Women
Timothy R. Wessel, MD;
Christopher B. Arant, MD;
Marian B. Olson, MS;
B. Delia Johnson, PhD;
Steven E. Reis, MD;
Barry L. Sharaf, MD;
Leslee J. Shaw, PhD;
Eileen Handberg, PhD;
George Sopko, MD;
Sheryl F. Kelsey, PhD;
Carl J. Pepine, MD;
C. Noel Bairey Merz, MD
JAMA. 2004;292:1179-1187.
Context Individual contributions of obesity and physical fitness (physical activity and functional capacity) to risk of coronary heart disease in women remain unclear.
Objective To investigate the relationships of measures of obesity (body mass index [BMI], waist circumference, waist-hip ratio, and waist-height ratio) and physical fitness (self-reported Duke Activity Status Index [DASI] and Postmenopausal Estrogen-Progestin Intervention questionnaire [PEPI-Q] scores) with coronary artery disease (CAD) risk factors, angiographic CAD, and adverse cardiovascular (CV) events in women evaluated for suspected myocardial ischemia.
Design, Setting, and Participants The National Heart, Lung, and Blood Institute–sponsored Women's Ischemia Syndrome Evaluation (WISE) is a multicenter prospective cohort study. From 1996-2000, 936 women were enrolled at 4 US academic medical centers at the time of clinically indicated coronary angiography and then assessed (mean follow-up, 3.9 [SD, 1.8] years) for adverse outcomes.
Main Outcome Measures Prevalence of obstructive CAD (any angiographic stenosis  50%) and incidence of adverse CV events (all-cause death or hospitalization for nonfatal myocardial infarction, stroke, congestive heart failure, unstable angina, or other vascular events) during follow-up.
Results Of 906 women (mean age, 58 [SD, 12] years) with complete data, 19% were of nonwhite race, 76% were overweight (BMI 25), 70% had low functional capacity (DASI scores <25, equivalent to  7 metabolic equivalents [METs]), and 39% had obstructive CAD. During follow-up, 337 (38%) women had a first adverse event, 118 (13%) had a major adverse event, and 68 (8%) died. Overweight women were more likely than normal weight women to have CAD risk factors, but neither BMI nor abdominal obesity measures were significantly associated with obstructive CAD or adverse CV events after adjusting for other risk factors (P = .05 to .88). Conversely, women with lower DASI scores were significantly more likely to have CAD risk factors and obstructive CAD (44% vs 26%, P<.001) at baseline, and each 1-MET increase in DASI score was independently associated with an 8% (hazard ratio, 0.92; 95% confidence interval, 0.85-0.99; P = .02) decrease in risk of major adverse CV events during follow-up.
Conclusions Among women undergoing coronary angiography for suspected ischemia, higher self-reported physical fitness scores were independently associated with fewer CAD risk factors, less angiographic CAD, and lower risk for adverse CV events. Measures of obesity were not independently associated with these outcomes.
Author Affiliations: Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville (Drs Wessel, Arant, Handberg, and Pepine); Cardiovascular Institute and Department of Epidemiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (Ms Olson and Drs Johnson, Reis, and Kelsey); Division of Cardiology, Rhode Island Hospital, Providence (Dr Sharaf); Atlanta Cardiovascular Research Institute, Atlanta, Ga (Dr Shaw); Division of Heart and Vascular Disease, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (Dr Sopko); Division of Cardiology, Department of Medicine, Cedars-Sinai Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (Dr Bairey Merz).
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