DALLAS — Physical fitness cancels out the excess mortality risk associated with the metabolic syndrome in asymptomatic women, Martha Gulati, M.D., said at the annual scientific sessions of the American Heart Association.
This finding from the large observational St. James Women Take Heart Project suggests that as part of a primary cardiovascular prevention strategy, physicians ought to routinely assess cardiorespiratory fitness in asymptomatic women who meet criteria for the metabolic syndrome (MS). By stratifying risk in this manner, the unfit can be targeted for more aggressive interventions, explained Dr. Gulati of Northwestern University, Chicago.
She reported on 5,721 asymptomatic women age 35–86 years who participated in the St. James Project, a prospective observational study whose primary purpose was to assess the value of exercise stress testing in asymptomatic women. The mean age of participants was 52 years. Thirty percent met National Cholesterol Education Program (NCEP) criteria for the MS.
The MS has been shown to confer at least a twofold increased risk of all-cause and cardiovascular mortality. That's why the condition received prominent attention in the NCEP Adult Treatment Panel III guidelines. The impetus for Dr. Gulati's study was a recognition that the impact of physical fitness upon this mortality risk hadn't previously been studied in women.
In 1992, participants underwent a symptom-limited Bruce protocol exercise stress test, then were followed prospectively through 2000. During a mean 8.4 years of follow-up, 180 women died, with one-third of the deaths being due to cardiac causes.
An unadjusted analysis showed that women with the MS were at least 1.5 times more likely to die from any cause, compared with those without it, and at least twice as likely to die from cardiac causes. Upon adjustment of the data for cardiorespiratory fitness, the MS was no longer an independent risk factor for mortality.