TY - JOUR
T1 - The interaction of exercise ability and body mass index upon long-term outcomes among patients undergoing stress-rest perfusion single-photon emission computed tomography imaging
AU - Uretsky, Seth
AU - Supariwala, Azhar
AU - Gurram, Srinivasa
AU - Bonda, Sri Lakshmi Kala
AU - Thota, Naganath
AU - Bezwada, Prema
AU - Manchireddy, Seema
AU - Nair, Subu
AU - Cohen, Randy
AU - Rozanski, Alan
PY - 2013/7
Y1 - 2013/7
N2 - Background The obesity paradox has been reported in several populations of patients with cardiovascular disease. Recent data have shown that physical fitness may attenuate the obesity paradox. Patients who undergo pharmacologic stress testing are known to have a higher risk of mortality than those who can exercise. The purpose of this study is to determine the interaction of obesity and exercise ability on survival among patients with a normal stress-rest single-photon emission computed tomography (SPECT). Methods A total of 5,203 (60 ± 13 years, male 37%) patients without a history of heart disease and a normal stress-rest SPECT between the years 1995 and 2010 were included in this analysis. Body mass index categories were defined according to the World Health Organization classification: normal weight, 18.5 to 24.9 kg/m2; overweight, 25 to 29.9 kg/m2; and obese, ≥30 kg/m2. Patients were divided into 3 groups based on their ability to exercise: those who reached ≥6 METs on exercise, those who attained a level of <6 METs, and those who required pharmacologic stress. Patients in each of these fitness groups were further divided into 3 subgroups based on their body mass index. Results There were 939 (18%) deaths during a mean follow-up of 8.1 ± 4.1 years, for an overall event rate of 2.3%/y. Both exercise to ≥6 METs and being obese were associated with lower mortality. Adjusted multivariate analysis using the obese high-fit patients as the reference showed a wide heterogeneity in annualized mortality rates according to exercise and weight status, with annualized event rates which varied from 0.6%/y in the obese subjects who were physically fit to 5.3%/y among healthy subjects who underwent pharmacologic stress testing (P <.001). Conclusions Stress mode and body weight impacted long-term survival in patients with a normal stress SPECT. The benefit of being physically fit was evident in all weight groups, as was the adverse effect of being unable to exercise. However, with regard to body weight, there was a paradoxical survival advantage for those patients who were overweight and obese, regardless of their exercise ability.
AB - Background The obesity paradox has been reported in several populations of patients with cardiovascular disease. Recent data have shown that physical fitness may attenuate the obesity paradox. Patients who undergo pharmacologic stress testing are known to have a higher risk of mortality than those who can exercise. The purpose of this study is to determine the interaction of obesity and exercise ability on survival among patients with a normal stress-rest single-photon emission computed tomography (SPECT). Methods A total of 5,203 (60 ± 13 years, male 37%) patients without a history of heart disease and a normal stress-rest SPECT between the years 1995 and 2010 were included in this analysis. Body mass index categories were defined according to the World Health Organization classification: normal weight, 18.5 to 24.9 kg/m2; overweight, 25 to 29.9 kg/m2; and obese, ≥30 kg/m2. Patients were divided into 3 groups based on their ability to exercise: those who reached ≥6 METs on exercise, those who attained a level of <6 METs, and those who required pharmacologic stress. Patients in each of these fitness groups were further divided into 3 subgroups based on their body mass index. Results There were 939 (18%) deaths during a mean follow-up of 8.1 ± 4.1 years, for an overall event rate of 2.3%/y. Both exercise to ≥6 METs and being obese were associated with lower mortality. Adjusted multivariate analysis using the obese high-fit patients as the reference showed a wide heterogeneity in annualized mortality rates according to exercise and weight status, with annualized event rates which varied from 0.6%/y in the obese subjects who were physically fit to 5.3%/y among healthy subjects who underwent pharmacologic stress testing (P <.001). Conclusions Stress mode and body weight impacted long-term survival in patients with a normal stress SPECT. The benefit of being physically fit was evident in all weight groups, as was the adverse effect of being unable to exercise. However, with regard to body weight, there was a paradoxical survival advantage for those patients who were overweight and obese, regardless of their exercise ability.
UR - http://www.scopus.com/inward/record.url?scp=84879786777&partnerID=8YFLogxK
U2 - 10.1016/j.ahj.2013.03.027
DO - 10.1016/j.ahj.2013.03.027
M3 - Article
C2 - 23816031
AN - SCOPUS:84879786777
SN - 0002-8703
VL - 166
SP - 127
EP - 133
JO - American Heart Journal
JF - American Heart Journal
IS - 1
ER -