Poor fitness, metabolic risk factors increase long-term heart disease risk for women
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Key takeaways:
- Women who are metabolically healthy but unfit or fit but metabolically unhealthy are at higher risk for long-term, major adverse CV events.
- Clinicians should screen women for physical activity levels.
In women with ischemic heart disease, poor fitness and metabolic syndrome with or without diabetes independently drive risks for obstructive coronary artery disease, long-term adverse events and all-cause mortality, researchers reported.
“Higher fitness has been associated with lower risk of CVD outcomes and mortality in individuals with metabolic risk factors. However, studies to date are largely limited to healthy cohorts without a known history of CVD, cohorts predominantly composed of men, or focus on just one metabolic risk factor,” Healio | Cardiology Today Editorial Board Member C. Noel Bairey Merz, MD, FACC, FAHA, professor of medicine (cardiology) and director of the Barbra Streisand Women’s Heart Center at the Smidt Heart Institute, Cedars-Sinai, and colleagues wrote in the American Journal of Preventive Cardiology. “Fitness is also associated with lower risk of developing diabetes and in women with diabetes, fitness has been associated with lower risk of CVD outcomes and mortality. The association of fitness and the cluster of metabolic risk factors that make up the metabolic syndrome on longer-term major adverse CV events and mortality in women with CVD remains unknown.”
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Merz and colleagues analyzed data from 492 women enrolled in the prospective Women’s Ischemia Syndrome Evaluation (WISE) cohort (1997-2001) who underwent invasive coronary angiography and had symptoms of ischemic heart disease. Researchers investigated the association of fitness, as well as metabolic syndrome and dysmetabolism, with long-term CV outcomes and all-cause mortality risk during a median 8.6 years of follow-up. Fitness was measured by self-reported Duke Activity Status Index (DASI), with fitness defined as more than 7 metabolic equivalents of task (METs).
Within the cohort, 19.5% of women were considered to be fit and metabolically healthy (reference), 14.4% were fit and met criteria for metabolic syndrome, 29.9% were deemed unfit but metabolically healthy and 36.2% were deemed unfit and met criteria for metabolic syndrome. At baseline, 32% of women had obstructive CAD.
Compared with the fit and healthy women, women who were fit but had metabolic syndrome were more than 50% as likely to experience a major adverse CV event during follow-up (HR = 1.52; 95% CI, 1.03-2.26), whereas women who were unfit and had metabolic syndrome were more than twice as likely to experience major adverse CV events during follow-up (HR = 2.42; 95% CI, 1.3-4.48).
Compared with fit and healthy women, those who were fit but had dysmetabolism, which included treated type 2 diabetes, were nearly twice as likely to die during follow-up (HR = 1.96; 95% CI, 1.29-3), with the risk rising threefold for women who were unfit with dysmetabolism (HR = 3; 95% CI, 1.66-5.43).
“When we used a higher DASI cutoff greater than 35 (> 10 METs) to determine difference in highly fit women, we found that women with metabolic syndrome and METs < 10 had a 2.6-fold higher risk of mortality compared to metabolically healthy fit women,” the researchers wrote. “These findings suggest that in women with ischemic heart disease, higher fitness may be needed to improve mortality.”
The researchers noted that because participants with poorer health are less likely to be fit, underlying disease may have introduced potential bias into the analyses; however, women with significant comorbidities were excluded from the WISE cohort and researchers adjusted for significant comorbidities in the analyses.
“The public health burden associated with metabolic syndrome and diabetes is substantial,” the researchers wrote. “This study highlights the importance of fitness assessments, easily obtained by a patient-reported measure, in risk stratification.”
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