Changes in fitness and fatness on the development of cardiovascular disease risk factors hypertension, metabolic syndrome, and hypercholesterolemia

J Am Coll Cardiol. 2012 Feb 14;59(7):665-72. doi: 10.1016/j.jacc.2011.11.013.


Objectives: This study sought examine the independent and combined associations of changes in fitness and fatness with the subsequent incidence of the cardiovascular disease (CVD) risk factors of hypertension, metabolic syndrome, and hypercholesterolemia.

Background: The relative and combined contributions of fitness and fatness to health are controversial, and few studies are available on the associations of changes in fitness and fatness with the development of CVD risk factors.

Methods: We followed up 3,148 healthy adults who received at least 3 medical examinations. Fitness was determined by using a maximal treadmill test. Fatness was expressed by percent body fat and body mass index. Changes in fitness and fatness between the first and second examinations were categorized into loss, stable, or gain groups.

Results: During the 6-year follow-up after the second examination, 752, 426, and 597 adults developed hypertension, metabolic syndrome, and hypercholesterolemia, respectively. Maintaining or improving fitness was associated with lower risk of developing each outcome, whereas increasing fatness was associated with higher risk of developing each outcome, after adjusting for possible confounders and fatness or fitness for each other (all p for trend <0.05). In the joint analyses, the increased risks associated with fat gain appeared to be attenuated, although not completely eliminated, when fitness was maintained or improved. In addition, the increased risks associated with fitness loss were also somewhat attenuated when fatness was reduced.

Conclusions: Both maintaining or improving fitness and preventing fat gain are important to reduce the risk of developing CVD risk factors in healthy adults.

Publication types

  • Comparative Study

MeSH terms

  • Adipose Tissue / physiology*
  • Adult
  • Exercise Test / methods
  • Female
  • Follow-Up Studies
  • Humans
  • Hypercholesterolemia / epidemiology*
  • Hypercholesterolemia / physiopathology
  • Hypercholesterolemia / prevention & control
  • Hypertension / epidemiology*
  • Hypertension / physiopathology
  • Hypertension / prevention & control
  • Male
  • Metabolic Syndrome / epidemiology*
  • Metabolic Syndrome / physiopathology
  • Metabolic Syndrome / prevention & control
  • Middle Aged
  • Physical Fitness / physiology*
  • Prospective Studies
  • Risk Factors