title: Interactive effects of obesity and physical fitness on risk of ischemic heart disease.
abstract: Obesity and low physical fitness are known risk factors for ischemic heart disease (IHD), but their interactive effects are unclear. Elucidation of interactions between these common, modifiable risk factors may help inform more effective preventive strategies. We examined interactive effects of obesity, aerobic fitness and muscular strength in late adolescence on risk of IHD in adulthood in a large national cohort.
  
  
  
  We conducted a national cohort study of all 1 547 407 military conscripts in Sweden during 1969-1997 (97-98% of all 18-year-old males each year). Aerobic fitness, muscular strength and body mass index (BMI) measurements were examined in relation to IHD identified from outpatient and inpatient diagnoses through 2012 (maximum age 62 years).
  
  
  
  There were 38 142 men diagnosed with IHD in 39.7 million person years of follow-up. High BMI or low aerobic fitness (but not muscular strength) was associated with higher risk of IHD, adjusting for family history and socioeconomic factors. The combination of high BMI (overweight/obese vs normal) and low aerobic fitness (lowest vs highest tertile) was associated with highest IHD risk (incidence rate ratio, 3.11; 95% confidence interval (CI), 2.91-3.31; P<0.001). These exposures had no additive and a negative multiplicative interaction (that is, their combined effect was less than the product of their separate effects). Low aerobic fitness was a strong risk factor even among those with normal BMI.
  
  
  
  In this large cohort study, low aerobic fitness or high BMI at age 18 was associated with higher risk of IHD in adulthood, with a negative multiplicative interaction. Low aerobic fitness appeared to account for a similar number of IHD cases among those with normal vs high BMI (that is, no additive interaction). These findings suggest that interventions to prevent IHD should begin early in life and include not only weight control but aerobic fitness, even among persons of normal weight.
authors.affiliation: Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: C
authors.initials: C
authors.lastname: Crump
authors.affiliation: Center for Primary Health Care Research, Lund University, Malmö, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Sundquist
authors.affiliation: Stanford Prevention Research Center, Stanford University, Stanford, CA, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Winkleby
authors.affiliation: Center for Primary Health Care Research, Lund University, Malmö, Sweden.
authors.forename: K
authors.initials: K
authors.lastname: Sundquist
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D004198:Disease Susceptibility; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D053580:Muscle Strength / Q000502:physiology; D017202:Myocardial Ischemia / Q000453:epidemiology* / Q000503:physiopathology*; D009765:Obesity / Q000453:epidemiology* / Q000503:physiopathology*; D010809:Physical Fitness / Q000502:physiology*; D018570:Risk Assessment; D012307:Risk Factors; D012959:Socioeconomic Factors; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult