Cardiorespiratory fitness, BMI, mortality, and cardiovascular disease in adults with overweight/obesity and type 2 diabetes
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Introduction: We estimated the effects of cardiorespiratory fitness (CRF) and body mass index (BMI) at baseline on mortality and cardiovascular disease events in people with type 2 diabetes who participated in the Look AHEAD randomized clinical trial. Methods: Look AHEAD compared effects of an intensive lifestyle intervention with diabetes support and education on cardiovascular disease events in 5145 adults age 45–76 yr with overweight/obesity and type 2 diabetes. In 4773 participants, we performed a secondary analysis of the association of baseline CRF during maximal treadmill test (expressed as metabolic equivalents (METs)) on mortality and cardiovascular disease events during a mean follow-up of 9.2 yr. Results: The mean (SD) CRF was 7.2 (2.0) METs. Adjusted for age, sex, race/ethnicity, BMI, intervention group, and β-blocker use, all-cause mortality rate was 30% lower per SD greater METs (hazard ratio (HR) = 0.70 (95% confidence interval, 0.60 to 0.81); rate difference (RD), −2.71 deaths/1000 person-years (95% confidence interval, −3.79 to −1.63)). Similarly, an SD greater METs predicted lower cardiovascular disease mortality (HR, 0.45; RD, −1.65 cases/1000 person-years) and a composite cardiovascular outcome (HR, 0.72; RD, −6.38). Effects of METs were homogeneous on the HR scale for most baseline variables and outcomes but heterogeneous for many on the RD scale, with greater RD in subgroups at greater risk of the outcomes. For example, all-cause mortality was lower by 7.6 deaths/1000 person-years per SD greater METs in those with a history of cardiovascular disease at baseline but lower by only 1.6 in those without such history. BMI adjusted for CRF had little or no effect on these outcomes. Conclusions: Greater CRF is associated with reduced risks of mortality and cardiovascular disease events.
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Baseline cardio-pulmonary fitness was associated with reduced risks of mortality and cardiovascular events during follow-up of 9.2 years.
“In addition, baseline cardio-pulmonary fitness was associated with reduced risks of mortality and CV events during follow-up of 9.2 years.60”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [60]
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- Authors
- WILLS, A. C., VAZQUEZ ARREOLA, E., OLAIYA, M. T., CURTIS, J. M., HELLGREN, M. I., HANSON, R. L., & KNOWLER, W. C.
- Affiliations
- National Institute of Diabetes and Digestive and Kidney Diseases (US)
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
- Venue
- Medicine & Science in Sports & Exercise
- Published
- 2022-02-15
- Volume
- 54
- Issue
- 6
- Pages
- 994-1001
- ISSN
- 0195-9131 (ISSN-L)
- 1530-0315
- PMC
- PMC9117407
- OpenAlex
- W4213041820
- Cited by
- 18
- References
- 32
- Citations by year
- 2026: 6 · 2025: 4 · 2024: 3 · 2023: 4 · 2022: 1
- FWCI
- 2.22
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Medicine & Science in Sports & Exercise (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (Z99 DK999999)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Keywords
- cardiorespiratory fitness, body mass index, type 2 diabetes, overweight, obesity, all-cause mortality, cardiovascular disease, Look AHEAD trial, metabolic equivalents, treadmill exercise testing, diabetes support and education, lifestyle intervention
- MeSH terms
- Cardiorespiratory Fitness, Aged, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Exercise Test, Humans, Middle Aged, Obesity, Physical Fitness, Risk Factors, Body Mass Index, Overweight
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