Most Cited Progress in Cardiovascular Diseases Articles
The most cited articles published since 2011, extracted from Scopus.
Overview of epidemiology and contribution of obesity to cardiovascular diseaseMarjorie Bastien | Paul Poirier | Isabelle Lemieux | Jean Pierre Després
Volume 56, Issue 4, January 2014, Pages 369-381
The prevalence of obesity has increased worldwide and is a source of concern since the negative consequences of obesity start as early as in childhood. The most commonly used anthropometric tool to assess relative weight and classify obesity is the body mass index (BMI); BMI alone shows a U- or a J-shaped association with clinical outcomes and mortality. Such an inverse relationship fuels a controversy in the literature, named the 'obesity paradox', which associates better survival and fewer cardiovascular (CV) events in patients with elevated BMI afflicted with chronic diseases compared to non-obese patients. However, BMI cannot make the distinction between an elevated body weight due to high levels of lean vs. fat body mass. Generally, an excess of body fat (BF) is more frequently associated with metabolic abnormalities than a high level of lean body mass. Another explanation for the paradox is the absence of control for major individual differences in regional BF distribution. Adipose tissue is now considered as a key organ regarding the fate of excess dietary lipids, which may determine whether or not body homeostasis will be maintained (metabolically healthy obesity) or a state of inflammation/insulin resistance will be produced, with deleterious CV consequences. Obesity, particularly visceral obesity, also induces a variety of structural adaptations/alterations in CV structure/function. Adipose tissue can now be considered as an endocrine organ orchestrating crucial interactions with vital organs and tissues such as the brain, the liver, the skeletal muscle, the heart and blood vessels themselves. Thus, the evidence reviewed in this paper suggests that adipose tissue quality/function is as important, if not more so, than its amount in determining the overall health and CV risks of overweight/obesity. © 2014 Elsevier Inc.
Fitness vs. fatness on all-cause mortality: A meta-analysisVaughn W. Barry | Meghan Baruth | Michael W. Beets | J. Larry Durstine | Jihong Liu | Steven N. Blair
Volume 56, Issue 4, January 2014, Pages 382-390
The purpose of this study was to quantify the joint association of cardiorespiratory fitness (CRF) and weight status on mortality from all causes using meta-analytical methodology. Studies were included if they were (1) prospective, (2) objectively measured CRF and body mass index (BMI), and (3) jointly assessed CRF and BMI with all-cause mortality. Ten articles were included in the final analysis. Pooled hazard ratios were assessed for each comparison group (i.e. normal weight-unfit, overweight-unfit and -fit, and obese-unfit and -fit) using a random-effects model. Compared to normal weight-fit individuals, unfit individuals had twice the risk of mortality regardless of BMI. Overweight and obese-fit individuals had similar mortality risks as normal weight-fit individuals. Furthermore, the obesity paradox may not influence fit individuals. Researchers, clinicians, and public health officials should focus on physical activity and fitness-based interventions rather than weight-loss driven approaches to reduce mortality risk. © 2014 Elsevier Inc.
The role of exercise and physical activity in weight loss and maintenanceDamon L. Swift | Neil M. Johannsen | Carl J. Lavie | Conrad P. Earnest | Timothy S. Church
Volume 56, Issue 4, January 2014, Pages 441-447
This review explores the role of physical activity (PA) and exercise training (ET) in the prevention of weight gain, initial weight loss, weight maintenance, and the obesity paradox. In particular, we will focus the discussion on the expected initial weight loss from different ET programs, and explore intensity/volume relationships. Based on the present literature, unless the overall volume of aerobic ET is very high, clinically significant weight loss is unlikely to occur. Also, ET also has an important role in weight regain after initial weight loss. Overall, aerobic ET programs consistent with public health recommendations may promote up to modest weight loss (~. 2. kg), however the weight loss on an individual level is highly heterogeneous. Clinicians should educate their patients on reasonable expectations of weight loss based on their physical activity program and emphasize that numerous health benefits occur from PA programs in the absence of weight loss. © 2014 Elsevier Inc.
Heart Rate Variability TodayBorejda Xhyheri | Olivia Manfrini | Massimiliano Mazzolini | Carmine Pizzi | Raffaele Bugiardini
Volume 55, Issue 3, November 2012, Pages 321-331
Heart rate variability (HRV) non-invasively assesses the activity of the autonomic nervous system. During the past 30. years, an increasing number of studies have related the imbalance of the autonomic nervous system (as assessed by HRV) to several pathophysiogical conditions, particularly in the setting of cardiovascular disease. Sudden death, coronary artery disease, heart failure, or merely cardiovascular risk factors (smoking, diabetes, hyperlipidemia, and hypertension) are the best-known clinical circumstances that can affect and/or be affected by the autonomic nervous system. Analyses of HRV variables have been proposed as a component of the clinical evaluation for patient risk stratification due to its independent prognostic information. Yet the potential for HRV to be used widely in clinical practice remains to be established. © 2012 Elsevier Inc.
Physical Activity and the Prevention of Cardiovascular Disease: From Evolution to EpidemiologyEdward Archer | Steven N. Blair
Volume 53, Issue 6, May 2011, Pages 387-396
For most of human history, the environmental demands of survival necessitated prodigious amounts of physical exertion. The avoidance of predators, hunting, gathering, and the literal "chopping wood and carrying water" of daily existence provided a wholesome dose of physical activity that obviated the need for deliberate exercise. Nevertheless, 21st century humans are now immersed within an environment explicitly designed to eliminate physical labor. Over the past century and especially the past 50 years, an accrual of epidemiological evidence has established that the unintended consequence of humankind's predilection for labor-saving contrivances is an epidemic of hypokinetically induced cardiovascular disease, morbidity, and mortality. This review surveys data from observational studies supporting the premise that physical activity, exercise training, and improvements in cardiorespiratory fitness are essential elements in the prevention and treatment of the cardiovascular diseases induced by an environment in which survival no longer obligates physical exertion. © 2011 Elsevier Inc.
Exercise in Obesity, Metabolic Syndrome, and DiabetesTim Church
Volume 53, Issue 6, May 2011, Pages 412-418
The risk of developing both metabolic syndrome and type 2 diabetes mellitus (T2DM) is inversely associated with regular exercise training (ET). Excess weight is also strongly associated with increased risk of both metabolic syndrome and T2DM. There is strong evidence that even a moderate amount of weight loss achieved through changes in diet and ET can greatly reduce the risk of developing T2DM.For the purpose of general health, exercise programs should have both aerobic and resistance training components. The 2008 federal physical activity (PA) guidelines recommend obtaining at least 150 minutes per week of moderate-intensity PA, 75 minutes per week of vigorous-intensity PA, or a combination of the 2. In addition, all individuals should strive for at least 2 days per week of resistance training activity. For the purpose of weight loss, the combination of ET and reduced energy intake has been found to be more effective than either alone. © 2011 Elsevier Inc.
Impact of Exercise Training on Psychological Risk FactorsCarl J. Lavie | Richard V. Milani | James H. O'Keefe | Thomas J. Lavie
Volume 53, Issue 6, May 2011, Pages 464-470
Although the role of psychological risk factors has been underemphasized, considerable evidence indicates the adverse effects of various psychosocial stressors in the pathogenesis and recovery from cardiovascular diseases. Substantial data, especially from cardiac rehabilitation and exercise training programs, have demonstrated the role of physical activity, exercise training, and cardiorespiratory fitness, to improve psychological risk factors, including depression, anxiety, hostility, and total psychological stress, as well as stress-related mortality. © 2011.
Cardiac Rehabilitation and Exercise Training in Secondary Coronary Heart Disease PreventionCarl J. Lavie | Richard V. Milani
Volume 53, Issue 6, May 2011, Pages 397-403
Substantial evidence indicates that increased levels of physical activity, exercise training, and overall cardiorespiratory fitness provide protection in primary and secondary coronary heart disease (CHD) prevention. Clearly, cardiac rehabilitation and exercise training (CRET) programs have been greatly underused in patients with CHD. We review the benefits of formal CRET programs on CHD risk factors including exercise capacity, obesity indices, plasma lipids, inflammation, and psychosocial stress as well as overall morbidity and mortality. These data support the fact that patients with CHD, especially after major CHD events, need routine referral to CRET programs; and patients should be vigorously encouraged to attend these valuable programs. © 2011.
The impact of obesity on risk factors and prevalence and prognosis of coronary heart disease-the obesity paradoxAlban De Schutter | Carl J. Lavie | Richard V. Milani
Volume 56, Issue 4, January 2014, Pages 401-408
Obesity is associated with a host of cardiovascular risk factors and its prevalence is rising rapidly. Despite strong evidence that obesity predisposes to the development and progression of coronary heart disease (CHD), numerous studies have shown an inverse relationship between various measures of obesity (most commonly body mass index) and outcomes in established CHD. In this article we review the evidence surrounding the < obesity paradox. ≫ in the secondary care of CHD patients and the CHD presentations where a paradox has been found. Finally we discuss the impact of cardiorespiratory fitness and a number of mechanisms which may offer potential explanations for this puzzling phenomenon. © 2014 Elsevier Inc.
Impact of obesity and weight loss on cardiac performance and morphology in adultsMartin A. Alpert | Jad Omran | Ankit Mehra | Sivakumar Ardhanari
Volume 56, Issue 4, January 2014, Pages 391-400
Obesity, particularly severe obesity is capable of producing hemodynamic alterations that predispose to changes in cardiac morphology and ventricular function. These include increased cardiac output, left ventricular hypertrophy and diastolic and systolic dysfunction of both ventricles. Facilitated by co-morbidities such as hypertension, the sleep apnea/obesity hypoventilation syndrome, and possibly certain neurohormonal and metabolic alterations, these abnormalities may predispose to left and right heart failure, a disorder known as obesity cardiomyopathy. © 2014 Elsevier Inc.
The concept of normal weight obesityEstefania Oliveros | Virend K. Somers | Ondrej Sochor | Kashish Goel | Francisco Lopez-Jimenez
Volume 56, Issue 4, January 2014, Pages 426-433
Individuals with normal body weight by body mass index (BMI) and high body fat percentage show a high degree of metabolic dysregulation. This phenomenon, defined as normal weight obesity, is associated with a significantly higher risk of developing metabolic syndrome, cardiometabolic dysfunction and with higher mortality. Recently, we have also shown that coronary artery disease patients with normal BMI and central obesity have the highest mortality risk as compared to other adiposity patterns. Therefore, it is important to recognize these high-risk groups for better adiposity-based risk stratification. There is a need for an updated definition of obesity based on adiposity, not on body weight. © 2014 Elsevier Inc.
Obesity paradox in end-stage kidney disease patientsJongha Park | Seyed Foad Ahmadi | Elani Streja | Miklos Z. Molnar | Katherine M. Flegal | Daniel Gillen | Csaba P. Kovesdy | Kamyar Kalantar-Zadeh
Volume 56, Issue 4, January 2014, Pages 415-425
In the general population, obesity is associated with increased cardiovascular risk and decreased survival. In patients with end-stage renal disease (ESRD), however, an "obesity paradox" or "reverse epidemiology" (to include lipid and hypertension paradoxes) has been consistently reported, i.e. a higher body mass index (BMI) is paradoxically associated with better survival. This survival advantage of large body size is relatively consistent for hemodialysis patients across racial and regional differences, although published results are mixed for peritoneal dialysis patients. Recent data indicate that both higher skeletal muscle mass and increased total body fat are protective, although there are mixed data on visceral (intra-abdominal) fat. The obesity paradox in ESRD is unlikely to be due to residual confounding alone and has biologic plausibility. Possible causes of the obesity paradox include protein-energy wasting and inflammation, time discrepancy among competitive risk factors (undernutrition versus overnutrition), hemodynamic stability, alteration of circulatory cytokines, sequestration of uremic toxin in adipose tissue, and endotoxin-lipoprotein interaction. The obesity paradox may have significant clinical implications in the management of ESRD patients especially if obese dialysis patients are forced to lose weight upon transplant wait-listing. Well-designed studies exploring the causes and consequences of the reverse epidemiology of cardiovascular risk factors, including the obesity paradox, among ESRD patients could provide more information on mechanisms. These could include controlled trials of nutritional and pharmacologic interventions to examine whether gain in lean body mass or even body fat can improve survival and quality of life in these patients. © 2014 Elsevier Inc.
Pulmonary Hypertension Associated With Left Heart Disease: Characteristics, Emerging Concepts, and Treatment StrategiesFrancois Haddad | Kristina Kudelko | Olaf Mercier | Bojan Vrtovec | Roham T. Zamanian | Vinicio De Jesus Perez
Volume 54, Issue 2, September 2011, Pages 154-167
Left heart disease (LHD) represents the most common causes of pulmonary hypertension (PH). Whether caused by systolic or diastolic dysfunction or valvular heart disease, a hallmark of PH associated with LHD is elevated left atrial pressure. In all cases, the increase in left atrial pressure causes a passive increase in pulmonary pressure. In some patients, a superimposed active component caused by pulmonary arterial vasoconstriction and vascular remodeling may lead to a further increase in pulmonary arterial pressure. When present, PH is associated with a worse prognosis in patients with LHD. In addition to local abnormalities in nitric oxide and endothelin production, gene modifiers such as serotonin polymorphisms may be associated with the pathogenesis of PH in LHD. Optimizing heart failure regimens and corrective valve surgery represent the cornerstone of the treatment of PH in LHD. Recent studies suggest that sildenafil, a phosphodiesterase-5 inhibitor, is a promising agent in the treatment of PH in LHD. Unloading the left ventricle with circulatory support may also reverse severe PH in patients with end-stage heart failure allowing candidacy to heart transplantation. © 2011 Elsevier Inc.
Epidemiology and Cost of Advanced Heart FailureCatherine Norton | Vasiliki V. Georgiopoulou | Andreas P. Kalogeropoulos | Javed Butler
Volume 54, Issue 2, September 2011, Pages 78-85
The public health impact and the need to intervene upon the worsening heart failure (HF) epidemic are currently a matter of national interest. The greater than $39 billion annual cost of caring for the 5.8 million patients living with HF in the United States places a considerable burden on the health care system. In 2006, HF was a contributing factor in more than 250,000 deaths. HF is the primary cause of more than 1 million and a contributing cause for more than 3 million hospitalizations. Because of lack of uniform definition, defining advanced HF precisely and, in turn, specifically assessing its epidemiology are difficult. However, with availability of more therapeutic options available for patients with advanced HF, the need to precisely define this entity is becoming ever more important. In general, patients with advanced HF have an extremely high mortality and morbidity and poor health status and quality of life. With the aging of the population and the worsening risk factor profile at large, for example, diabetes mellitus and obesity, the current epidemiological trends in advanced HF will likely get worse. Newer medical and device therapies as well as regenerative techniques hold considerable promise for these patients in future. © 2011 Elsevier Inc.
Weight loss strategies for treatment of obesityRobert F. Kushner
Volume 56, Issue 4, January 2014, Pages 465-472
Obesity is one of the most serious and prevalent non-communicable diseases of the 21st century. It is also a patient-centered condition in which affected individuals seek treatment through a variety of commercial, medical and surgical approaches. Considering obesity as a chronic medical disease state helps to frame the concept of using a three-stepped intensification of care approach to weight management. As a foundation, all patients should be counseled on evidence-based lifestyle approaches that include diet, physical activity and behavior change therapies. At the second tier, two new pharmacological agents, phentermine-topiramate and lorcaserin, were approved in 2012 as adjuncts to lifestyle modification. The third step, bariatric surgery, has been demonstrated to be the most effective and long-term treatment for individuals with severe obesity or moderate obesity complicated by comorbid conditions that is not responsive to non-surgical approaches. By using a medical model, clinicians can provide more proactive and effective treatments in assisting their patients with weight loss. © 2014 Elsevier Inc.
Obesity and the obesity paradox in heart failureAdrienne L. Clark | Gregg C. Fonarow | Tamara B. Horwich
Volume 56, Issue 4, January 2014, Pages 409-414
Obesity is a growing public health problem in the general population, and significantly increases the risk for the development of new-onset heart failure (HF). However, in the setting of chronic HF, overweight and mild to moderate obesity is associated with substantially improved survival compared to normal-weight patients. Evidence exists for an "obesity paradox" in HF, with the majority of data measuring obesity by body mass index, but also across various less-frequently used measures of body fat (BF) and body composition including waist circumference, waist-hip ratio, skinfold estimates of percent BF, and bioelectrical impedance analysis of body composition. Other emerging areas of investigation such as the relationship of the obesity paradox to cardiorespiratory fitness are also discussed. Finally, this review explores various explanations for the obesity paradox, and summarizes the current evidence for intentional weight loss treatments for HF in context. © 2014 Elsevier Inc.
Depression and cardiovascular diseaseLarkin Elderon | Mary A. Whooley
Volume 55, Issue 6, May 2013, Pages 511-523
Approximately one out of every five patients with cardiovascular disease (CVD) suffers from major depressive disorder (MDD). Both MDD and depressive symptoms are risk factors for CVD incidence, severity and outcomes. Great progress has been made in understanding potential mediators between MDD and CVD, particularly focusing on health behaviors. Investigators have also made considerable strides in the diagnosis and treatment of depression among patients with CVD. At the same time, many research questions remain. In what settings is depression screening most effective for patients with CVD? What is the optimal screening frequency? Which therapies are safe and effective? How can we better integrate the care of mental health conditions with that of CVD? How do we motivate depressed patients to change health behaviors? What technological tools can we use to improve care for depression? Gaining a more thorough understanding of the links between MDD and heart disease, and how best to diagnose and treat depression among these patients, has the potential to substantially reduce morbidity and mortality from CVD. © 2013.
Assessment of Left Ventricular Hypertrophy in a Trained Athlete: Differential Diagnosis of Physiologic Athlete's Heart From Pathologic HypertrophyAntonio Pelliccia | Martin S. Maron | Barry J. Maron
Volume 54, Issue 5, March 2012, Pages 387-396
Physiologic LV remodeling in young trained athletes as a consequence of chronic training can occasionally mimic certain pathologic conditions associated with sudden death, such as HCM. A small but important subset ofelite male athletes may show a borderline increased LV wall thickness of 13 to 15 mm, which defines a gray zone of overlap between the extreme expressions of athlete's heart and a mild HCM phenotype. Such diagnostic ambiguity can be resolved by using the paradigm of noninvasive parameters including testing with echocardiography (and, more recently, with CMR): left atrial and LV chamber dimensions and shape, brief periods of deconditioning to alter LV mass, measurement of oxygen consumption and diastolic filling, and recognition of familial occurrence of HCM or a pathogenic HCM-causing sarcomere mutation. Such distinctions between physiologic/benign athlete's heart and HCM, the most common cause of sudden death in the young in the United States, can be crucial. The recognition of HCM leads to disqualification from intense competitive sports to reduce sudden death risk and, when appropriate, permits initiation of therapeutic interventions. © 2012 Elsevier Inc..
Heart rate variability in risk stratification of cardiac patientsHeikki V. Huikuri | Phyllis K. Stein
Volume 56, Issue 2, September 2013, Pages 153-159
Heart rate (HR) variability has been extensively studied in cardiac patients, especially in patients surviving an acute myocardial infarction (AMI) and also in patients with congestive heart failure (CHF) or left ventricular (LV) dysfunction. The majority of studies have shown that patients with reduced or abnormal HR variability have an increased risk of mortality within a few years after an AMI or after a diagnosis of CHF/LV dysfunction. Various measures of HR dynamics, such as time-domain, spectral, and non-linear measures of HR variability have been used in risk stratification. The prognostic power of various measures, except of those reflecting rapid R-R interval oscillations, has been almost identical, albeit some non-linear HR variability measures, such as short-term fractal scaling exponent have provided somewhat better prognostic information than the others. Abnormal HR variability predicts both sudden and non-sudden cardiac death. Because of remodeling of the arrhythmia substrate after AMI, early measurement of HR variability to identify those at high risk should likely be repeated later in order to assess the risk of fatal arrhythmia events. Future randomized trials using HR variability/turbulence as one of the pre-defined inclusion criteria will show whether routine measurement of HR variability/turbulence will become a routine clinical tool for risk stratification of cardiac patients. © 2013 Elsevier Inc.
Immune and inflammatory mechanisms in pulmonary arterial hypertensionHala El Chami | Paul M. Hassoun
Volume 55, Issue 2, September 2012, Pages 218-228
Altered immunity and inflammation are increasingly recognized features of pulmonary arterial hypertension (PAH). This is suggested by infiltration of various inflammatory cells (e.g., macrophages, T and B lymphocytes), increased cytokine and growth factor (e.g., VEGF and PDGF) expression in remodeled pulmonary vessels, and the presence of circulating chemokines and cytokines. In certain diseases associated with PAH, increased expression of growth and transcriptional (e.g., Nuclear Factor of Activated T cells or NFAT) factors, and viral protein components (e.g., HIV-1 Nef), appear to contribute directly to recruitment of inflammatory cells in remodeled vessels, and may potentially serve as specific therapeutic targets. This section provides an overview of inflammatory pathways highlighting their potential role in pulmonary vascular remodeling in PAH and the possibility of future targeted therapy. © 2012 Elsevier Inc.
Investigating Air Pollution and Atherosclerosis in Humans: Concepts and OutlookNino Künzli | Laura Perez | Stephanie von Klot | Damiano Baldassarre | Marcus Bauer | Xavier Basagana | Carrie Breton | Julia Dratva | Roberto Elosua | Ulf de Faire | Kateryna Fuks | Eric de Groot | Jaume Marrugat | Johanna Penell | Jochen Seissler | Annette Peters | Barbara Hoffmann
Volume 53, Issue 5, March 2011, Pages 334-343
Although ambient particulate matter contributes to atherosclerosis in animal models, its role in atherogenesis in humans needs to be established. This article discusses concepts, study design, and choice of health outcomes to efficiently investigate the atherogenic role of ambient air pollution, with an emphasis on early preclinical biomarkers of atherosclerosis that are unaffected by short-term exposure to air pollution (eg, carotid intima-media thickness [CIMT] and functional performance of the vessel). Air pollution studies using these end points are summarized. The CIMT is currently the most frequently used outcome in this field (6 studies). The continuous nature of CIMT, the lack of short-term variation, its relationship to atherosclerotic changes in the artery wall, its predictive value for coronary heart disease, and the noninvasiveness of the assessment make it a useful candidate for cross-sectional and longitudinal studies investigating the role of air pollution in atherogenesis. © 2011 Elsevier Inc.
Gene-Air Pollution Interaction and Cardiovascular Disease: A ReviewAntonella Zanobetti | Andrea Baccarelli | Joel Schwartz
Volume 53, Issue 5, March 2011, Pages 344-352
Genetic susceptibility is likely to play a role in response to air pollution. Hence, gene-environment interaction studies can be a tool for exploring the mechanisms and the importance of the pathway in the association between air pollution and a cardiovascular outcome.In this article, we present a systematic review of the studies that have examined gene-environment interactions in relation to the cardiovascular health effects of air pollutants.We identified 16 articles meeting our search criteria. Of these studies, most have focused on individual functional polymorphisms or individual candidate genes. Moreover, they were all based on 3 study populations that have been extensively investigated in relation to air pollution effects: the Normative Aging Study, Air Pollution and Inflammatory Response in Myocardial Infarction Survivors: Gene-Environment Interaction in a High Risk Group, and Multiethnic Study of Atherosclerosis.In conclusions, the studies differed substantially in both the cardiovascular outcomes examined and the polymorphisms examined, so there is little confirmation of results across cohorts. Gene-environment interaction studies can help explore the mechanisms and the potential pathway in the association between air pollution and a cardiovascular outcome; replication of findings and studies involving multiple cohorts would be needed to draw stronger conclusions. © 2011 Elsevier Inc.
Management of pregnancy in patients with congenital heart diseaseIan S. Harris
Volume 53, Issue 4, January 2011, Pages 305-311
Congenital heart diseases are the most common birth defects in humans, affecting approximately 0.8% of all live births. In the past, many of the more severe defects resulted in profound disability and death during childhood, and adult survival was exceptional. The past 4 decades have seen dramatic improvements in the survival and quality of life of patients with the more severe defects. As a result of these improvements, the challenges of caring for adults with congenital heart disease are only now being realized. Most women with congenital heart disease are now expected to reach childbearing age and maternal cardiac disease is the major cause of maternal morbidity and mortality. As such, appropriate pre-pregnancy counseling and management during pregnancy are fundamental components of the care of these patients. This article describes the circulatory changes that occur during normal pregnancy and delivery, addresses the risks posed during pregnancy by specific congenital lesions, and reviews the current data on pregnancy outcomes in patients with individual congenital defects. © 2011 Elsevier Inc.
Contribution of cardiorespiratory fitness to the obesity paradoxPaul A. McAuley | Kristen M. Beavers
Volume 56, Issue 4, January 2014, Pages 434-440
Until recently, cardiorespiratory fitness (CRF) has been overlooked as a potential modifier of the inverse association between obesity and mortality (the so-called obesity paradox), observed in patients with known or suspected cardiovascular (CV) disease. Evidence from five observational cohort studies of 30,104 patients (87% male) with CV disease indicates that CRF significantly alters the obesity paradox. There is general agreement across studies that the obesity paradox persists among patients with low CRF, regardless of whether adiposity is assessed by body mass index, waist circumference, or percentage body fat. However, among patients with high CRF, risk of all-cause mortality is lowest for the overweight category in some, but not all, studies, suggesting that higher levels of fitness may modify the relationship between body fatness and survival in patients manifesting an obesity paradox. Further study is needed to better characterize the joint contribution of CRF and obesity on mortality in diverse populations. © 2014 Elsevier Inc.
Physical Activity and Cardiorespiratory Fitness as Major Markers of Cardiovascular Risk: Their Independent and Interwoven Importance to Health StatusJonathan Myers | Paul McAuley | Carl J. Lavie | Jean Pierre Despres | Ross Arena | Peter Kokkinos
Volume 57, Issue 4, January 2015, Pages 306-314
© 2014. The evolution from hunting and gathering to agriculture, followed by industrialization, has had a profound effect on human physical activity (PA) patterns. Current PA patterns are undoubtedly the lowest they have been in human history, with particularly marked declines in recent generations, and future projections indicate further declines around the globe. Non-communicable health problems that afflict current societies are fundamentally attributable to the fact that PA patterns are markedly different than those for which humans were genetically adapted. The advent of modern statistics and epidemiological methods has made it possible to quantify the independent effects of cardiorespiratory fitness (CRF) and PA on health outcomes. Based on more than five decades of epidemiological studies, it is now widely accepted that higher PA patterns and levels of CRF are associated with better health outcomes. This review will discuss the evidence supporting the premise that PA and CRF are independent risk factors for cardiovascular disease (CVD) as well as the interplay between both PA and CRF and other CVD risk factors. A particular focus will be given to the interplay between CRF, metabolic risk and obesity.