title: Obesity and exercise-induced ectopic ventricular arrhythmias in apparently healthy middle aged adults.
abstract: BACKGROUND
  Obesity and overweight are strongly associated with cardiovascular morbidity and mortality. However, there are limited data on the association between excess weight and the risk of ectopic ventricular activity.
  
  
  METHODS
  We investigated the association between body mass index (BMI) and the risk for ectopic ventricular activity (defined as multiple ventricular premature beats (≥3), ventricular bigeminy, nonsustained ventricular tachycardia or sustained ventricular tachycardia) during exercise stress testing among 22,516 apparently healthy men and women who attended periodic health screening examinations between the years 2000 and 2014. All subjects had completed maximal exercise stress testing annually according to the Bruce protocol. Subjects were divided at baseline into three groups: normal weight (BMI ≥ 18.5 kg/m(2) and<25; N = 9,994), overweight (BMI ≥ 25 and < 30; N = 9,613) and obese (BMI ≥ 30; N = 2,906).
  
  
  RESULTS
  The mean age of study subjects was 47 ± 10 years and 72% were men. Kaplan-Meier survival analysis showed that the cumulative probability for the development of exercise-induced ectopic ventricular activity arrhythmias was highest among obese subjects, intermediate among overweight subjects and lowest among subjects with normal weight (3.4%, 2.7% and 2.2% respectively; p < 0.001). Multivariate binary logistic regression with repeated measures of 92,619 ESTs, showed that obese subjects were 33% more likely to have ectopic ventricular arrhythmias during exercise compared with subjects with normal weight (p = 0.005), and that each 1 kg/m(2) increase in BMI was associated with a significant 4% (p = 0.002) increased adjusted risk for exercise-induced ventricular arrhythmias.
  
  
  CONCLUSIONS
  Obesity is independently associated with increased likelihood of ectopic ventricular arrhythmia during exercise.
authors.affiliation: Leviev Heart Center, Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Israel.
authors.forename: Avi
authors.initials: A
authors.lastname: Sabbag
authors.affiliation: Department of Internal Medicine C, Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Israel.
authors.forename: Yechezkel
authors.initials: Y
authors.lastname: Sidi
authors.affiliation: Department of Internal Medicine C, Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Israel.
authors.forename: Shaye
authors.initials: S
authors.lastname: Kivity
authors.affiliation: Leviev Heart Center, Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Israel.
authors.forename: Roy
authors.initials: R
authors.lastname: Beinart
authors.affiliation: Leviev Heart Center, Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Glikson
authors.affiliation: Institute for Medical Screening, Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Israel.
authors.forename: Shlomo
authors.initials: S
authors.lastname: Segev
authors.affiliation: Leviev Heart Center, Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Israel.
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
authors.affiliation: Leviev Heart Center, Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Israel Pinchas Borenstein Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Israel Elad.Maor@sheba.health.gov.il.
authors.forename: Elad
authors.initials: E
authors.lastname: Maor
mesh_terms: D000328:Adult; D000367:Age Factors; D015992:Body Mass Index; D016009:Chi-Square Distribution; D015444:Exercise; D005080:Exercise Test; D005260:Female; D006339:Heart Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications* / Q000175:diagnosis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D018879:Ventricular Premature Complexes / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology
keywords: Obesity; arrhythmia; exercise testing