title: The obesity paradox, cardiorespiratory fitness, and coronary heart disease.
abstract: OBJECTIVE
  To investigate associations of cardiorespiratory fitness (CRF) and different measures of adiposity with cardiovascular disease (CVD) and all-cause mortality in men with known or suspected coronary heart disease (CHD).
  
  
  METHODS
  We analyzed data from 9563 men (mean age, 47.4 years) with documented or suspected CHD in the Aerobics Center Longitudinal Study (August 13, 1977, to December 30, 2002) using baseline body mass index (BMI) and CRF (quantified as the duration of a symptom-limited maximal treadmill exercise test). Waist circumference (WC) and percent body fat (BF) were measured using standard procedures.
  
  
  RESULTS
  There were 733 deaths (348 of CVD) during a mean follow-up of 13.4 years. After adjustment for age, examination year, and multiple baseline risk factors, men with low fitness had a higher risk of all-cause mortality in the BMI categories of normal weight (hazard ratio [HR], 1.60; 95% confidence interval [CI], 1.24-2.05), obese class I (HR, 1.38; 95% CI, 1.04-1.82), and obese class II/III (HR, 2.43; 95% CI, 1.55-3.80) but not overweight (HR, 1.09; 95% CI, 0.88-1.36) compared with the normal-weight and high-fitness reference group. We observed a similar pattern for WC and percent BF tertiles and for CVD mortality. Among men with high fitness, there were no significant differences in CVD and all-cause mortality risk across BMI, WC, and percent BF categories.
  
  
  CONCLUSIONS
  In men with documented or suspected CHD, CRF greatly modifies the relation of adiposity to mortality. Using adiposity to assess mortality risk in patients with CHD may be misleading unless fitness is considered.
authors.affiliation: Department of Human Performance and Sport Sciences, Winston-Salem State University, NC 27110, USA. mcauleypa@wssu.edu
authors.forename: Paul A
authors.initials: PA
authors.lastname: McAuley
authors.forename: Enrique G
authors.initials: EG
authors.lastname: Artero
authors.forename: Xuemei
authors.initials: X
authors.lastname: Sui
authors.forename: Duck-chul
authors.initials: DC
authors.lastname: Lee
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Church
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Lavie
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Myers
authors.forename: Vanesa
authors.initials: V
authors.lastname: España-Romero
authors.forename: Steven N
authors.initials: SN
authors.lastname: Blair
mesh_terms: D050154:Adiposity; D000368:Aged; D001823:Body Composition; D015992:Body Mass Index; D001835:Body Weight; D002320:Cardiovascular Physiological Phenomena; D002423:Cause of Death; D015897:Comorbidity; D016001:Confidence Intervals; D003327:Coronary Disease / Q000453:epidemiology* / Q000503:physiopathology*; D015444:Exercise; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology* / Q000503:physiopathology*; D016017:Odds Ratio; D010809:Physical Fitness; D012143:Respiratory Physiological Phenomena; D012307:Risk Factors; D049629:Waist-Hip Ratio