Fatness Is a Better Predictor of Cardiovascular Disease Risk Factor Profile Than Aerobic Fitness in Healthy Men Demetra D. Christou, PhD; Christopher L. Gentile, MS; Christopher A. DeSouza, PhD; Douglas R. Seals, PhD; Phillip E. Gates, PhD Background—The prevalence of cardiovascular disease (CVD) is partly attributable to an inactive and/or overweight population. However, the independent association of body fatness and aerobic fitness with CVD risk factors is uncertain. We sought to determine whether fatness or fitness better predicted traditional CVD risk factors in men with broad fatness, aerobic fitness, and age ranges using 3 expressions of adiposity. Methods and Results—In 135 carefully screened healthy men, we measured 18 established CVD risk factors, body mass index, total percent body fat, waist circumference, and maximal aerobic capacity. Body mass index, percent body fat, and waist circumference were consistently associated with all metabolic risk factors (r=-0.44 to 0.51, P0.05) after partialling out the effects of aerobic fitness and age. Body mass index and waist circumference were also independently associated with selective hemodynamic risk factors (r=0.20 to 0.30, P0.01). In contrast, aerobic fitness was independently associated with only selective metabolic risk factors (r=-0.21 to 0.19, P0.05) and was not associated with any hemodynamic risk factors (P0.05). Both aerobic fitness and body fatness were independently associated with selective hemostatic risk factors (r=-0.22 to -0.26, P0.01; r=-0.32 to 0.48, P0.05, respectively). Overall, fatness was more strongly and consistently associated with CVD risk factors than aerobic fitness. Conclusions—Body fatness is a better predictor of CVD risk factor profile than aerobic fitness in healthy men. Although habitual physical activity is an effective strategy for preventing CVD, elevated body fatness is associated with an adverse CVD risk factor profile independently of aerobic fitness. (Circulation. 2005;111:1904-1914.) Key Words: blood pressure  fibrinolysis  exercise  obesity R ecent emphasis has been placed on the importance of risk factors in predicting morbidity and mortality from cardiovascular disease (CVD) and understanding disease progression and natural history. 1–6 In addition, there is a need to understand how CVD risk is influenced by physical characteristics that are modified by lifestyle behaviors. Low aerobic fitness and increased body fatness are of particular interest, given that the prevalence of CVD in the United States is at least partly attributable to a largely inactive and/or overweight population. 7,8 It is well established that aerobic exercise is cardioprotec- tive 7,9 and that being overweight increases the risk of CVD. 10,11 However, because low physical activity and in- creased adiposity often occur in combination, masking their independent effects, it is unclear whether lower aerobic fitness or higher body fatness exerts a greater influence on CVD risk factors. With more adults becoming overweight or obese, this issue is increasingly important for the implemen- tation of effective public health policy, prevention strategies, and patient management. The limited available data on the importance of body fatness compared with aerobic fitness to specific CVD risk factors are equivocal. 12–17 These discrepancies likely are attributable to the use of different expressions of body fatness and aerobic fitness, the grouping of subjects according to body fatness/aerobic fitness, and the use of different markers of CVD risk. Moreover, many studies have focused on a single risk factor despite the multifactorial nature of CVD and the common “clustering” of CVD risk factors. 1,18 As such, it is difficult to draw conclusions about the relative contribu- tions of body fatness and aerobic fitness to the CVD risk factor profile. Therefore, a clear need exists to determine whether aerobic fitness or body fatness contributes more to intermediary phenotypic CVD risk factors in healthy adults. Moreover, it is critical to conduct such an analysis in a subject cohort with a Received November 5, 2004; revision received January 11, 2005; accepted February 3, 2005. From the Department of Integrative Physiology, University of Colorado, Boulder (D.D.C., C.L.G., C.A.D., D.R.S., P.E.G.), and Department of Medicine, Divisions of Cardiology (D.R.S.) and Geriatric Medicine (C.A.D., D.R.S.), University of Colorado Health Sciences Center, Denver. Correspondence to Demetra D. Christou, PhD, Department of Integrative Physiology, University of Colorado at Boulder, 354 UCB, Boulder, CO 80309. E-mail christou@colorado.edu © 2005 American Heart Association, Inc. Circulation is available at http://www.circulationaha.org DOI: 10.1161/01.CIR.0000161818.28974.1A 1904 Exercise Physiology by guest on April 3, 2017 http://circ.ahajournals.org/ Downloaded from