The Obesity Paradox and Cardiorespiratory Fitness in Men and Women with Known or Suspected Coronary Artery Disease

Abstract

It has been suggested that cardiorespiratory fitness may alter the association between obesity and risk of mortality among individuals with coronary artery disease (CAD). A systematic search of the literature was conducted to evaluate the joint association of cardiorespiratory fitness and obesity with mortality in the CAD population. Literature published from database inception was searched using the MEDLINE, CINAHL, EMBASE and EBM databases and incorporated 3 concepts: (1) condition (i.e., coronary disease, myocardial infarction) (2) fitness (i.e., oxygen consumption) and fatness (i.e., body mass index (BMI)) and (3) outcomes (all-cause or cardiovascular mortality). A total of 3 articles were identified including 22,835 (n = 162 female) individuals with known or suspected CAD. Results of these investigations suggest that individuals with low cardiorespiratory fitness had a higher risk of overall-mortality across BMI categories of normal weight, overweight or obese with normal weight-high cardiorespiratory fitness as the reference group. Moreover, individuals who were overweight or obese with high cardiorespiratory fitness had a lower or similar risk of overall-mortality compared to those with low cardiorespiratory fitness across all BMI categories. Higher cardiorespiratory fitness may reduce the risk of mortality to a greater extent when compared to obesity among the CAD population.