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.
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This work was supported by the National Heart, Lung, and Blood Institute at the National Institutes of Health (R01 HL116381 to K.S.); the Swedish Research Council; and ALF project grant, Region Skåne/Lund University, Sweden. The funding agencies had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript.
JS had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis; study concept and design: CC, JS, MAW and KS; acquisition of data: JS and KS; analysis and interpretation of data: CC, JS, MAW and KS; drafting of the manuscript: CC; critical revision of the manuscript for important intellectual content: CC, JS, MAW and KS; statistical analysis: CC and JS; obtained funding: JS and KS.
The authors declare no conflict of interest.
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Crump, C., Sundquist, J., Winkleby, M. et al. Interactive effects of obesity and physical fitness on risk of ischemic heart disease. Int J Obes 41, 255–261 (2017). https://doi.org/10.1038/ijo.2016.209
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