The interaction of exercise ability and body mass index upon long-term outcomes among patients undergoing stress-rest perfusion single-photon emission computed tomography imaging

Seth Uretsky, Azhar Supariwala, Srinivasa Gurram, Sri Lakshmi Kala Bonda, Naganath Thota, Prema Bezwada, Seema Manchireddy, Subu Nair, Randy Cohen, Alan Rozanski

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background The obesity paradox has been reported in several populations of patients with cardiovascular disease. Recent data have shown that physical fitness may attenuate the obesity paradox. Patients who undergo pharmacologic stress testing are known to have a higher risk of mortality than those who can exercise. The purpose of this study is to determine the interaction of obesity and exercise ability on survival among patients with a normal stress-rest single-photon emission computed tomography (SPECT). Methods A total of 5,203 (60 ± 13 years, male 37%) patients without a history of heart disease and a normal stress-rest SPECT between the years 1995 and 2010 were included in this analysis. Body mass index categories were defined according to the World Health Organization classification: normal weight, 18.5 to 24.9 kg/m2; overweight, 25 to 29.9 kg/m2; and obese, ≥30 kg/m2. Patients were divided into 3 groups based on their ability to exercise: those who reached ≥6 METs on exercise, those who attained a level of <6 METs, and those who required pharmacologic stress. Patients in each of these fitness groups were further divided into 3 subgroups based on their body mass index. Results There were 939 (18%) deaths during a mean follow-up of 8.1 ± 4.1 years, for an overall event rate of 2.3%/y. Both exercise to ≥6 METs and being obese were associated with lower mortality. Adjusted multivariate analysis using the obese high-fit patients as the reference showed a wide heterogeneity in annualized mortality rates according to exercise and weight status, with annualized event rates which varied from 0.6%/y in the obese subjects who were physically fit to 5.3%/y among healthy subjects who underwent pharmacologic stress testing (P <.001). Conclusions Stress mode and body weight impacted long-term survival in patients with a normal stress SPECT. The benefit of being physically fit was evident in all weight groups, as was the adverse effect of being unable to exercise. However, with regard to body weight, there was a paradoxical survival advantage for those patients who were overweight and obese, regardless of their exercise ability.

Original languageEnglish (US)
Pages (from-to)127-133
Number of pages7
JournalAmerican Heart Journal
Volume166
Issue number1
DOIs
StatePublished - Jul 1 2013
Externally publishedYes

Fingerprint

Single-Photon Emission-Computed Tomography
Body Mass Index
Perfusion
Exercise
Obesity
Weights and Measures
Survival
Mortality
Body Weight
Physical Fitness
Heart Diseases
Healthy Volunteers
Cardiovascular Diseases
Multivariate Analysis
Population

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Uretsky, Seth ; Supariwala, Azhar ; Gurram, Srinivasa ; Bonda, Sri Lakshmi Kala ; Thota, Naganath ; Bezwada, Prema ; Manchireddy, Seema ; Nair, Subu ; Cohen, Randy ; Rozanski, Alan. / The interaction of exercise ability and body mass index upon long-term outcomes among patients undergoing stress-rest perfusion single-photon emission computed tomography imaging. In: American Heart Journal. 2013 ; Vol. 166, No. 1. pp. 127-133.
@article{4ff5971aba53418d8345613046ede3c3,
title = "The interaction of exercise ability and body mass index upon long-term outcomes among patients undergoing stress-rest perfusion single-photon emission computed tomography imaging",
abstract = "Background The obesity paradox has been reported in several populations of patients with cardiovascular disease. Recent data have shown that physical fitness may attenuate the obesity paradox. Patients who undergo pharmacologic stress testing are known to have a higher risk of mortality than those who can exercise. The purpose of this study is to determine the interaction of obesity and exercise ability on survival among patients with a normal stress-rest single-photon emission computed tomography (SPECT). Methods A total of 5,203 (60 ± 13 years, male 37{\%}) patients without a history of heart disease and a normal stress-rest SPECT between the years 1995 and 2010 were included in this analysis. Body mass index categories were defined according to the World Health Organization classification: normal weight, 18.5 to 24.9 kg/m2; overweight, 25 to 29.9 kg/m2; and obese, ≥30 kg/m2. Patients were divided into 3 groups based on their ability to exercise: those who reached ≥6 METs on exercise, those who attained a level of <6 METs, and those who required pharmacologic stress. Patients in each of these fitness groups were further divided into 3 subgroups based on their body mass index. Results There were 939 (18{\%}) deaths during a mean follow-up of 8.1 ± 4.1 years, for an overall event rate of 2.3{\%}/y. Both exercise to ≥6 METs and being obese were associated with lower mortality. Adjusted multivariate analysis using the obese high-fit patients as the reference showed a wide heterogeneity in annualized mortality rates according to exercise and weight status, with annualized event rates which varied from 0.6{\%}/y in the obese subjects who were physically fit to 5.3{\%}/y among healthy subjects who underwent pharmacologic stress testing (P <.001). Conclusions Stress mode and body weight impacted long-term survival in patients with a normal stress SPECT. The benefit of being physically fit was evident in all weight groups, as was the adverse effect of being unable to exercise. However, with regard to body weight, there was a paradoxical survival advantage for those patients who were overweight and obese, regardless of their exercise ability.",
author = "Seth Uretsky and Azhar Supariwala and Srinivasa Gurram and Bonda, {Sri Lakshmi Kala} and Naganath Thota and Prema Bezwada and Seema Manchireddy and Subu Nair and Randy Cohen and Alan Rozanski",
year = "2013",
month = "7",
day = "1",
doi = "10.1016/j.ahj.2013.03.027",
language = "English (US)",
volume = "166",
pages = "127--133",
journal = "American Heart Journal",
issn = "0002-8703",
publisher = "Mosby Inc.",
number = "1",

}

The interaction of exercise ability and body mass index upon long-term outcomes among patients undergoing stress-rest perfusion single-photon emission computed tomography imaging. / Uretsky, Seth; Supariwala, Azhar; Gurram, Srinivasa; Bonda, Sri Lakshmi Kala; Thota, Naganath; Bezwada, Prema; Manchireddy, Seema; Nair, Subu; Cohen, Randy; Rozanski, Alan.

In: American Heart Journal, Vol. 166, No. 1, 01.07.2013, p. 127-133.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The interaction of exercise ability and body mass index upon long-term outcomes among patients undergoing stress-rest perfusion single-photon emission computed tomography imaging

AU - Uretsky, Seth

AU - Supariwala, Azhar

AU - Gurram, Srinivasa

AU - Bonda, Sri Lakshmi Kala

AU - Thota, Naganath

AU - Bezwada, Prema

AU - Manchireddy, Seema

AU - Nair, Subu

AU - Cohen, Randy

AU - Rozanski, Alan

PY - 2013/7/1

Y1 - 2013/7/1

N2 - Background The obesity paradox has been reported in several populations of patients with cardiovascular disease. Recent data have shown that physical fitness may attenuate the obesity paradox. Patients who undergo pharmacologic stress testing are known to have a higher risk of mortality than those who can exercise. The purpose of this study is to determine the interaction of obesity and exercise ability on survival among patients with a normal stress-rest single-photon emission computed tomography (SPECT). Methods A total of 5,203 (60 ± 13 years, male 37%) patients without a history of heart disease and a normal stress-rest SPECT between the years 1995 and 2010 were included in this analysis. Body mass index categories were defined according to the World Health Organization classification: normal weight, 18.5 to 24.9 kg/m2; overweight, 25 to 29.9 kg/m2; and obese, ≥30 kg/m2. Patients were divided into 3 groups based on their ability to exercise: those who reached ≥6 METs on exercise, those who attained a level of <6 METs, and those who required pharmacologic stress. Patients in each of these fitness groups were further divided into 3 subgroups based on their body mass index. Results There were 939 (18%) deaths during a mean follow-up of 8.1 ± 4.1 years, for an overall event rate of 2.3%/y. Both exercise to ≥6 METs and being obese were associated with lower mortality. Adjusted multivariate analysis using the obese high-fit patients as the reference showed a wide heterogeneity in annualized mortality rates according to exercise and weight status, with annualized event rates which varied from 0.6%/y in the obese subjects who were physically fit to 5.3%/y among healthy subjects who underwent pharmacologic stress testing (P <.001). Conclusions Stress mode and body weight impacted long-term survival in patients with a normal stress SPECT. The benefit of being physically fit was evident in all weight groups, as was the adverse effect of being unable to exercise. However, with regard to body weight, there was a paradoxical survival advantage for those patients who were overweight and obese, regardless of their exercise ability.

AB - Background The obesity paradox has been reported in several populations of patients with cardiovascular disease. Recent data have shown that physical fitness may attenuate the obesity paradox. Patients who undergo pharmacologic stress testing are known to have a higher risk of mortality than those who can exercise. The purpose of this study is to determine the interaction of obesity and exercise ability on survival among patients with a normal stress-rest single-photon emission computed tomography (SPECT). Methods A total of 5,203 (60 ± 13 years, male 37%) patients without a history of heart disease and a normal stress-rest SPECT between the years 1995 and 2010 were included in this analysis. Body mass index categories were defined according to the World Health Organization classification: normal weight, 18.5 to 24.9 kg/m2; overweight, 25 to 29.9 kg/m2; and obese, ≥30 kg/m2. Patients were divided into 3 groups based on their ability to exercise: those who reached ≥6 METs on exercise, those who attained a level of <6 METs, and those who required pharmacologic stress. Patients in each of these fitness groups were further divided into 3 subgroups based on their body mass index. Results There were 939 (18%) deaths during a mean follow-up of 8.1 ± 4.1 years, for an overall event rate of 2.3%/y. Both exercise to ≥6 METs and being obese were associated with lower mortality. Adjusted multivariate analysis using the obese high-fit patients as the reference showed a wide heterogeneity in annualized mortality rates according to exercise and weight status, with annualized event rates which varied from 0.6%/y in the obese subjects who were physically fit to 5.3%/y among healthy subjects who underwent pharmacologic stress testing (P <.001). Conclusions Stress mode and body weight impacted long-term survival in patients with a normal stress SPECT. The benefit of being physically fit was evident in all weight groups, as was the adverse effect of being unable to exercise. However, with regard to body weight, there was a paradoxical survival advantage for those patients who were overweight and obese, regardless of their exercise ability.

UR - http://www.scopus.com/inward/record.url?scp=84879786777&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84879786777&partnerID=8YFLogxK

U2 - 10.1016/j.ahj.2013.03.027

DO - 10.1016/j.ahj.2013.03.027

M3 - Article

C2 - 23816031

AN - SCOPUS:84879786777

VL - 166

SP - 127

EP - 133

JO - American Heart Journal

JF - American Heart Journal

SN - 0002-8703

IS - 1

ER -