Physical activity,obesity and risk of cardiovascular disease in middle-aged men during a median of 30 years of follow-up

Abstract

Background

We aimed to investigate associations between combinations of body mass index (BMI)-categories, levels of physical activity and long-term risk of cardiovascular disease.

Method and results

At age 50 years, cardiovascular risk factors were assessed in 2196 participating men of the ULSAM-study. This investigation was repeated at age 60, 70, 77 and 82 years. Being physically active (PA) was defined as three hours of recreational or hard physical training per week. The men were categorized according to BMI/PA-status, as PA/normal weight (n = 593 at baseline), non-PA/normal weight (BMI < 25 kg/m², n = 580), PA/overweight (n = 418), non-PA/overweight (BMI 25–30 kg/m², n = 462), PA/obese (n = 62), non-PA/obese (BMI >30 kg/m², n = 81). We used updated data on BMI and physical activity obtained at all examinations. During follow-up (median 30 years) 850 individuals suffered a cardiovascular disease (myocardial infarction, stroke or heart failure). Using updated data on BMI/PA categories, an increased risk for cardiovascular disease was seen with increasing BMI, but a high physical activity was associated with a lower risk of cardiovascular disease within each BMI category: non-PA/normal weight (hazard ratio (HR) 1.31, 95% confidence interval (CI) 1.04–1.66), PA/overweight (HR 1.52, 95% CI 1.20–1.94), non-PA/overweight (HR 1.65, 95% CI 1.31–2.07) PA/obese (HR 2.05, 95% CI 1.44–2.92) and non-PA/obese (HR 2.39, 95% CI 1.74–3.29), using PA/normal weight men as referent.

Conclusions

Although physical activity was beneficial at all levels of BMI regarding the risk of future cardiovascular disease, there was still a substantial increased risk associated with being overweight or obese during 30 years of follow-up.

Keywords

Epidemiology lifetime risk lifestyle obesity

Get full access to this article

View all access options for this article.

References

Haslam

James

. Obesity. Lancet 2005; 366: 1197–1209.

Mark

. Dietary therapy for obesity: An emperor with no clothes. Hypertension 2008; 51: 1426–1434; discussion 1434.

Santaniemi

Ukkola

Malo

. Metabolic syndrome in the prediction of cardiovascular events: The potential additive role of hsCRP and adiponectin. Eur J Prev Cardiol 2014; 21: 1242–1248.

Pischon

Boeing

Hoffmann

. General and abdominal adiposity and risk of death in Europe. N Engl J Med 2008; 359: 2105–2120.

Wandell

Carlsson

Theobald

. The association between BMI value and long-term mortality. Int J Obes (Lond) 2009; 33: 577–582.

Cabal-Hierro

Lazo

. Signal transduction by tumor necrosis factor receptors. Cell Signal 2012; 24: 1297–1305.

Carlsson

Riserus

Arnlov

. Prediction of cardiovascular disease by abdominal obesity measures is dependent on body weight and sex – results from two community based cohort studies. Nutr Metab Cardiovasc Dis 2014; 24: 891–899.

Carlsson

Riserus

Engstrom

. Novel and established anthropometric measures and the prediction of incident cardiovascular disease: A cohort study. Int J Obes (Lond) 2013; 37: 1579–1585.

Zhang

Rexrode

van Dam

. Abdominal obesity and the risk of all-cause, cardiovascular, and cancer mortality: Sixteen years of follow-up in US women. Circulation 2008; 117: 1658–1667.

10.

Barengo

Tuomilehto

. Relationship of physical activity and body mass index to the risk of hypertension: A prospective study in Finland. Hypertension 2004; 43: 25–30.

11.

McAuley

Blair

. Obesity paradoxes. J Sports Sci 2011; 29: 773–782.

12.

Rana

Manson

. Obesity as compared with physical activity in predicting risk of coronary heart disease in women. Circulation 2006; 113: 499–506.

13.

Byberg

Melhus

Gedeborg

. Total mortality after changes in leisure time physical activity in 50 year old men: 35 year follow-up of population based cohort. BMJ 2009; 338: b688–b688.

14.

Carlsson

Larsson

Helmersson-Karlqvist

. Urinary kidney injury molecule 1 and incidence of heart failure in elderly men. Eur J Heart Fail 2013; 15: 441–446.

15.

Sundstrom

Riserus

Byberg

. Clinical value of the metabolic syndrome for long term prediction of total and cardiovascular mortality: Prospective, population based cohort study. BMJ 2006; 332: 878–882.

16.

Byberg

Zethelius

McKeigue

. Changes in physical activity are associated with changes in metabolic cardiovascular risk factors. Diabetologia 2001; 44: 2134–2139.

17.

Lochen

Rasmussen

. The Tromsø study: Physical fitness, self reported physical activity, and their relationship to other coronary risk factors. J Epidemiol Community Health 1992; 46: 103–107.

18.

Rosengren

Wilhelmsen

. Physical activity protects against coronary death and deaths from all causes in middle-aged men. Evidence from a 20-year follow-up of the primary prevention study in Goteborg. Ann Epidemiol 1997; 7: 69–75.

19.

Ingelsson

Arnlov

Sundstrom

. The validity of a diagnosis of heart failure in a hospital discharge register. Eur J Heart Fail 2005; 7: 787–791.

20.

Guidelines for the diagnosis of heart failure. The Task Force on Heart Failure of the European Society of Cardiology. Eur Heart J 1995; 16: 741–751.

21.

Lee

Blair

Jackson

. Cardiorespiratory fitness, body composition, and all-cause and cardiovascular disease mortality in men. Am J Clin Nutr 1999; 69: 373–380.

22.

Sui

LaMonte

Laditka

. Cardiorespiratory fitness and adiposity as mortality predictors in older adults. JAMA 2007; 298: 2507–2516.

23.

Lee

Sui

Church

. Changes in fitness and fatness on the development of cardiovascular disease risk factors hypertension, metabolic syndrome, and hypercholesterolemia. J Am Coll Cardiol 2012; 59: 665–672.

24.

Carlsson

Theobald

Wandell

. Health factors and longevity in men and women: A 26-year follow-up study. Eur J Epidemiol 2010; 25: 547–551.

25.

Willett

. Adiposity as compared with physical activity in predicting mortality among women. N Engl J Med 2004; 351: 2694–2703.

26.

Stevens

Cai

Evenson

. Fitness and fatness as predictors of mortality from all causes and from cardiovascular disease in men and women in the lipid research clinics study. Am J Epidemiol 2002; 156: 832–841.

27.

McAuley

Sui

Church

. The joint effects of cardiorespiratory fitness and adiposity on mortality risk in men with hypertension. American journal of hypertension 2009; 22(10): 1062–9.

28.

Wei

Kampert

Barlow

. Relationship between low cardiorespiratory fitness and mortality in normal-weight, overweight, and obese men. JAMA 1999; 282: 1547–1553.

29.

Ingelsson

Arnlov

Sundstrom

. Relative importance and conjoint effects of obesity and physical inactivity for the development of insulin resistance. Eur J Cardiovasc Prev Rehabil 2009; 16: 28–33.

30.

Carlsson

Wandell

de Faire

. Risk factors associated with newly diagnosed high blood pressure in men and women. Am J Hypertens 2008; 21: 771–777.

31.

Carmena

Ascaso

Real

. Impact of obesity in primary hyperlipidemias. Nutr Metab Cardiovasc Dis 2001; 11: 354–359.

32.

Despres

Lemieux

. Abdominal obesity and metabolic syndrome. Nature 2006; 444: 881–887.

33.

Sulo

Igland

Nygard

. Favourable trends in incidence of AMI in Norway during 2001–2009 do not include younger adults: A CVDNOR project. Eur J Prev Cardiol 2014; 21: 1358–1364.