Cardiorespiratory Fitness and Atherosclerotic Cardiovascular Outcomes by Levels of Baseline Predicted Cardiovascular Risk: The Look AHEAD Study

ABSTRACT Background We evaluated the associations of cardiorespiratory fitness with atherosclerotic cardiovascular disease (ASCVD) by levels of baseline predicted ASCVD risk among adults with type 2 diabetes. Methods We analyzed data from 4203 adults with type 2 diabetes in the Look AHEAD (Action for Health in Diabetes) study. Cardiorespiratory fitness was assessed using maximal exercise testing and categorized into low, moderate, and high; baseline predicted ASCVD risk was calculated using the ACC/AHA Pooled Cohort Equation. We used Cox regression models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for ASCVD events (fatal and non-fatal myocardial infarction and stroke). Results Over a median of 9.6 years, there were 295 ASCVD events. The effect of fitness on outcomes was different across levels of 10-year predicted ASCVD risk (P for interaction Conclusions In a large sample of type 2 diabetes individuals, the association of low fitness with incident ASCVD was modified by the baseline predicted 10-year ASCVD risk. Our findings suggest the utility of assessing fitness in ASCVD risk stratification in type 2 diabetes, especially among those with intermediate predicted 10-year risk of ASCVD.