Fitness Cuts Mortality in Metabolic Syndrome

Physical fitness cancels out the excess mortality risk associated with the metabolic syndrome in asymptomatic women.

This finding from a large observational study, the St. James Women Take Heart Project, has important clinical implications: It 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.

If risk is stratified in this manner, women who are not fit can be targeted for more aggressive interventions, explained Dr. Gulati of Northwestern University, Chicago.

She reported on 5,721 asymptomatic women aged 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 metabolic syndrome.

Metabolic syndrome 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, and 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 metabolic syndrome 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.

After adjustment of the data for cardiorespiratory fitness, however, metabolic syndrome was no longer an independent risk factor for mortality.

“What this ultimately means is that fitness is more important than the presence or absence of the metabolic syndrome,” Dr. Gulati said.

The investigators defined high fitness as an exercise capacity in excess of 8 standard metabolic equivalents (METs) and low fitness as less than 5 METs. The age-adjusted baseline prevalence of metabolic syndrome was 25% in unfit women, 20% in those with an exercise capacity of 5-8 METs, and less than 10% in women with high fitness.

A formal treadmill test isn’t necessary to evaluate cardiorespiratory fitness. A reasonable estimate can be gleaned through an activity inventory. For example, 8 METs are roughly equivalent to jogging at a 12-minute-mile pace, the cardiologist noted. AHA Scientific meeting.

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