Cardiorespiratory Fitness and Metabolic Risk

doi:10.1016/j.amjcard.2011.11.031

The American Journal of Cardiology

Volume 109, Issue 7, 1 April 2012, Pages 988-993

https://doi.org/10.1016/j.amjcard.2011.11.031 Get rights and content

The present study sought to evaluate the relation between cardiovascular risk factors and cardiorespiratory fitness (CRF) in a large population. Low CRF has been associated with increased total mortality and cardiovascular mortality. The mechanisms underlying greater cardiovascular mortality have not yet been determined. A series of cardiovascular risk factors were measured in 59,820 men and 22,192 women who had undergone determinations of CRF with maximal exercise testing. The risk factor profiles were segregated into 5 quintiles of CRF. With decreasing CRF, increases occurred in obesity, triglycerides, non–high-density lipoprotein cholesterol, triglyceride/high-density lipoprotein ratios, blood pressure, metabolic syndrome, diabetes, and cigarette smoking. Self-reported physical activity declined with decreasing levels of CRF. In conclusion, it appears likely that the enrichment of cardiovascular risk factors, especially metabolic risk factors, account for a portion of the increased cardiovascular mortality in low-fitness subjects. The mechanisms responsible for this enrichment in subjects with a low CRF represent a challenge for future research.

Section snippets

Methods

CCLS was a prospective cohort study of participants aged 20 to 90 years who visited the Cooper Clinic (Dallas, Texas) for the first time from 1970 to 2009 and completed a maximal graded exercise treadmill test. These criteria resulted in 59,820 men and 22,192 women for the present analysis.

The details of the medical examination, including anthropometric and laboratory measures and metabolic syndrome diagnosis have been previously reported.3, 4, 5 The risk factor measures included in the present

Results

The baseline characteristics of the participants are listed in Table 1. The total CVD and CHD deaths for CCLS from 1970 through 2006 across the quintiles of CRF are shown in Figure 1. The total number of men was 53,772 and of women was 18,852. Mortality relative risk was set at 1.0 for CRF at quintile 5, the most fit group. In men, the relative risk for both CVD and CHD mortality increased progressively with decreasing CRF. The shape of the inverse relation appeared to be curvilinear. A

Discussion

The present analysis has confirmed previous reports that lower CRF is associated with increases in CVD risk factors. However, previous reports focused primarily on the relation between CRF and mortality—and less on the overall pattern of risk factors in consecutive CRF categories.1, 2 The results from the present study have shown in detail the patterns of the association of CVD risk factors in each CRF category. The risk factor levels, on average, were tightly linked to CRF category. The

Acknowledgment

We thank Kenneth H. Cooper, MD for establishing the CCLS, the Cooper Clinic physicians and technicians for data collection, and the Cooper Institute staff for data management.

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Higher mitochondrial oxidative capacity is the primary molecular differentiator in muscle of rats with high and low intrinsic cardiorespiratory fitness
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Cardiorespiratory fitness (CRF) is tightly linked with health and longevity and is implicated in metabolic flexibility and substrate metabolism. The high capacity runner (HCR) and low capacity runner (LCR) rat lines are a genetically heterogeneous rat model selected and bred for CRF that reflect CRF in humans by exhibiting differences in nutrient handling. This study aims to differentiate the intrinsic substrate preference of the HCR compared to LCR rats to better understand the intersection of mitochondrial respiration and intrinsic CRF.
We performed bulk skeletal muscle RNA-Sequencing on male and female HCR and LCR rats and assessed the effect of rat line on mitochondrial gene expression pathways using the MitoCarta3.0 database. In a separate cohort of rats, mitochondria were isolated from skeletal and cardiac muscle and maximal oxidation rates were measured using an Oroboros O2k when provided either pyruvate or fatty acid substrates.
The expression of mitochondrial genes are significantly upregulated in HCR skeletal muscle in both male and female rats. In respirometry experiments, fatty acid oxidative capacities were greater in HCR compared to LCR, and male compared to female rats, as a function of both mitochondrial quality and mitochondrial density. This effect was greater in the skeletal muscle than in the heart. Pyruvate oxidation did not differ significantly between lines.
The capacity for increased fatty acid oxidation in the HCR rat is a result of selection for running capacity and is likely a key contributor to the healthy metabolic phenotype of individuals with high CRF.
Fatness, fitness and the aging brain: A cross sectional study of the associations between a physiological estimate of brain age and physical fitness, activity, sleep, and body composition
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Changes in brain structure and function occur with aging. However, there is substantial heterogeneity both in terms of when these changes begin, and the rate at which they progress. Understanding the mechanisms and/or behaviors underlying this heterogeneity may allow us to act to target and slow negative changes associated with aging.
Using T1 weighted MRI images, we applied a novel algorithm to determine the physiological age of the brain (brain-predicted age) and the predicted age difference between this physiologically based estimate and chronological age (BrainPAD) to 551 sedentary adults aged 65 to 84 with self-reported cognitive complaint measured at baseline as part of a larger study. We also assessed maximal aerobic capacity with a graded exercise test, physical activity and sleep with accelerometers, and body composition with dual energy x-ray absorptiometry. Associations were explored both linearly and logistically using categorical groupings.
Visceral Adipose Tissue (VAT), Total Sleep Time (TST) and maximal aerobic capacity all showed significant associations with BrainPAD. Greater VAT was associated with higher (i.e,. older than chronological) BrainPAD (r = 0.149 p = 0.001)Greater TST was associated with higher BrainPAD (r = 0.087 p = 0.042) and greater aerobic capacity was associated with lower BrainPAD (r = −0.088 p = 0.040). With linear regression, both VAT and TST remained significant (p = 0.036 and 0.008 respectively). Each kg of VAT predicted a 0.741 year increase in BrainPAD, and each hour of increased TST predicted a 0.735 year increase in BrainPAD. Maximal aerobic capacity did not retain statistical significance in fully adjusted linear models.
Accumulation of visceral adipose tissue and greater total sleep time, but not aerobic capacity, total daily physical activity, or sleep quantity and/or quality are associated with brains that are physiologically older than would be expected based upon chronological age alone (BrainPAD).
Is post-transplant metabolic syndrome associated with pre-liver transplant visceral adipose tissue area?
2020, Clinical Nutrition ESPEN
Citation Excerpt :
It has also been proposed that a high ratio of VAT to subcutaneous adipose tissue (SAT) [VAT:SAT ratio] carries an even higher metabolic risk [11]. Previous population studies have identified other independent predictors of metabolic complications after liver transplantation including low skeletal muscle mass, reduced strength and poor cardiorespiratory fitness [12–16]. The risk that these factors carry with regards to PTMS has not been previously assessed.
Post-liver transplant metabolic syndrome (PTMS) is a significant independent risk factor for the development of cardiovascular disease. The impact of pre-transplant body composition on the risk of developing PTMS has not been evaluated and was the aim of this study.
Seventy-five consecutive adult patients listed for liver transplant were included in the analysis. Anthropometric and metabolic data were collected pre-transplant and at three months post-transplant. Metabolic syndrome was defined in accordance with international guidelines. Skeletal muscle area (SMA), visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) areas were derived from computed tomography.
Ten patients (13%) developed de novo PTMS by 3 months post-transplant. Patients who developed PTMS had higher pre-transplant body mass index (BMI) (P = 0.01), VAT (P = 0.001) and SAT (P = 0.008). Univariate logistic regression found that BMI, VAT and SAT were significant predictors for the development of PTMS. After stepwise multivariate analysis, only VAT remained a significant predictor (OR 1.02, 95%CI 1.01–1.04; P = 0.04).
Higher pre-transplant VAT is independently associated with the development of metabolic syndrome three months post-transplant. Body composition analysis using cross-sectional imaging prior to liver transplant can assist with identifying patients at greatest risk for developing PTMS.
Change in Maximal Exercise Capacity Is Associated With Survival in Men and Women
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To describe the relationship between change in maximal exercise capacity (MEC) over time and risk of all-cause mortality separately in men and women.
Consecutive patients (n=10,854; mean ± SD age, 54±11 years; 43% women; 30% nonwhite) who completed 2 physician-referred exercise tests between January 2, 1991, and May 28, 2009, were identified from the Henry Ford Exercise Testing (FIT) Project. The MEC was quantified in metabolic equivalents of task (METs) calculated from peak workload on a treadmill and adjusted to the equivalent for a 50-year-old man. Multivariable Cox proportional hazards regression was performed to assess risk of all-cause mortality associated with change in MEC based on (1) change from age-/sex-adjusted low fitness (<8 METs) to intermediate or high fitness and (2) an absolute change in METs.
Relative to patients with low fitness at both tests, increasing from low to intermediate or high fitness was associated with lower risk of all-cause mortality (adjusted hazard ratio [aHR] = 0.63 [95% CI, 0.45-0.87] in men and 0.56 [95% CI, 0.34-0.91] in women). Each 1-MET increase in age-/sex-adjusted MEC between baseline and follow-up was associated with an aHR of 0.87 (95% CI, 0.84-0.91) in men and 0.84 (95% CI, 0.79-0.89) in women, with no significant interaction by sex (P=.995). Similar aHRs were observed in a subgroup with intermediate fitness at baseline.
In men and women referred for an exercise stress test, change in MEC over time is inversely related to risk of all-cause mortality.
U.S. military service and the prevalence of metabolic syndrome: Findings from a cross-sectional analysis of the Cooper Center Longitudinal Study, 1979–2013
2017, Preventive Medicine
Citation Excerpt :
The NCEP ATP III requires three or more of the following five criteria for a diagnosis of metabolic syndrome in men: (1) waist circumference ≥ 102 cm; (2) triglyceride level ≥ 150 mg/dL; (3) high density lipoprotein cholesterol (HDL-C) < 40 mg/dL; (4) systolic blood pressure ≥ 130 mm Hg or treatment with antihypertensive medications; (5) diastolic blood pressure ≥ 85 mm Hg; and (6) fasting glucose ≥ 100 mg/dL or treatment with diabetic medications (Grundy et al., 2005; Grundy et al., 2004). Since medication history was not available in the CCLS dataset, we adhered to an approach used in previous CCLS studies (LaMonte et al., 2005; Shuval et al., 2012; Grundy et al., 2012) and utilized either self-reported history of hypertension/diabetes or laboratory data to determine if each criterion was satisfactorily met. Participants were classified as meeting or not meeting the criteria for metabolic syndrome.
U.S. military service confers both health benefits and risks potentially associated with a clustering of cardiovascular risk factors called metabolic syndrome. However, the association between prior military service and metabolic syndrome has not sufficiently been examined. The purpose of the study was to compare the prevalence of metabolic syndrome by prior military service status. Among 42,370 men (887 with prior military service) examined from 1979 to 2013 at the Cooper Clinic (Dallas, TX), we used a cross-sectional study design to examine the association between military service and metabolic syndrome. First, an unadjusted log binomial regression model was performed by regressing the prevalence of metabolic syndrome on prior service. This was followed by performing Kleinbaum's modeling strategy for assessing confounding. The same methodology was used to explore the association between individual metabolic syndrome risk factors and prior service. Prior military service was not significantly associated with the prevalence of metabolic syndrome (PR = 0.98, 0.89–1.07). None of the variables explored were identified as confounders. Participants with prior military service had lower prevalence of both elevated levels of triglycerides (PR = 0.89, 0.80–0.99) and low levels of high-density lipoprotein-cholesterol (PR = 0.78, 0.70–0.88). They had a higher prevalence of elevated resting systolic blood pressure (PR = 1.23, 1.12–1.35). However, none of these associations were significant after adjusting for identified confounders: age; cardiorespiratory fitness; and exam year. Study findings indicate that military service was not independently associated with the prevalence of metabolic syndrome or its components. Future research is warranted longitudinally assessing the impact of military service on long-term outcomes.
Association of triglyceride-to-high density lipoprotein cholesterol ratio to cardiorespiratory fitness in men
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Both triglyceride-to-high density lipoprotein cholesterol (TG/HDL-C) and cardiorespiratory fitness (CRF) impart risk for all-cause morbidity and mortality independently of conventional risk factors.
To determine prevalence and/or incidence of high TG/HDL-C ratio in men with low CRF.
Clinical characteristics and CRF were used to determine prevalence of a TG/HDL-C ratio ≥ 3.5 (high ratio) in 13,954 men of the Cooper Center Longitudinal Study. High-ratio conversion was determined in 10,424 men with normal baseline TG/HDL-C ratio. Hazard ratio (HR) of incident high TG/HDL-C was adjusted for age and waist girth.
Men with low CRF had the highest prevalence of a high TG/HDL-C ratio. In the population with normal TG/HDL-C, age-adjusted HR of incident high TG/HDL-C ratio was 2.77 times higher in men with lowest CRF than in those with highest CRF. Incidence of conversion of normal to high ratio was 5.5% per year in low CRF population, compared with 1.7% in high CRF subjects. Incidence HR was independent of waist girth. Men who converted from normal to high TG/HDL-C ratio during the follow-up period had increased number of metabolic risk factors and a higher prevalence of metabolic syndrome. Men who did not convert to a high TG/HDL-C ratio retained a low prevalence of metabolic syndrome risk factors.
A high TG/HDL-C ratio is common in men with low CRF. Metabolic syndrome also is common among those with a high ratio.

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Preventive cardiologyCardiorespiratory Fitness and Metabolic Risk

Section snippets

Methods

Results

Discussion

Acknowledgment

Am J Clin Nutr

Chest

Endocrinol Metab Clin North Am

Physical fitness and all-cause mortality: a prospective study of healthy men and women

JAMA

Mortality trends in the general population: the importance of cardiorespiratory fitness

J Psychopharmacol

Recommendations for blood pressure measurement in humans and experimental animalsPart 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research

Hypertension

Circulation

Compendium of physical activities: an update of activity codes and MET intensities

Med Sci Sports Exer

Comparison of leisure-time physical activity and cardiorespiratory fitness as predictors of all-cause mortality in men and women

Br J Sports Med

Effects of intensity of aerobic training on VO2 max

Med Sci Sports Ex

Preventive cardiology
Cardiorespiratory Fitness and Metabolic Risk

Effects of intensity of aerobic training on VO_{2 max}