Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

BMI & CRF in Midlife & Long-Term HF Risk

JACC: Heart Fail; ePub 2017 Apr 5; Pandey, et al

Differences in cardiorespiratory fitness (CRF) levels essentially explain higher body mass index (BMI)-associated risk of heart failure (HF); however, change in BMI is not significantly associated with HF risk after adjusting for CRF changes, a recent study found. The Cooper Center Longitudinal study included 19,485 participants from 1999 to 2009 with associations of BMI and BMI change with HF hospitalization after age 65 years assessed. Researchers found:

  • After 127,110 person-years of follow-up, 1,038 HF hospitalizations were observed.
  • Higher midlife BMI was significantly associated with greater risk of HF hospitalization, after adjusting for established HF risk factors (HR, 1.19).
  • This association was lessened after adjusting for CRF (HR, 1.10).
  • CRF accounted for 47% of the HF risk associated with BMI.
  • BMI change was not, however, significantly associated with risk of HF in older age, after adjustment for CRF change.


Pandey A, Cornwall WK, Willis B, et al. Body mass index and cardiorespiratory fitness in mid-life and risk of heart failure hospitalization in older age. Findings from the Cooper Center Longitudinal Study. [Published online ahead of print April 5, 2017]. JACC: Heart Fail. doi:10.1016/j.jchf.2016.12.021.


If we were to pick 1 intervention that is more important than another to prevent the development of a wide range of diseases, it would be exercise, and this study adds CHF in patients with elevated BMI to the list. It is clear from previous studies that increased fitness decreases the likelihood of developing hypertension and leads to a decrease in blood pressure among individuals who have hypertension.1,2 Studies have also shown that improvement in fitness in middle age leads to better cardiovascular outcomes later in life.3 In fact, a large body of evidence now indicates that CRF is a stronger predictor of cardiovascular outcomes and mortality than established risk factors such as smoking, hypertension, high cholesterol, and even diabetes. The current study supports CRF as a better predictor of the development of CHF than BMI and thus, emphasis on exercise should be an important aspect of routine office visits. —Neil Skolnik, MD

  1. Kokkinos P. Cardiorespiratory fitness, exercise, and blood pressure. Hypertension.2014;64(6):1160-1164.
  2. Sui X, Sarzynski MA, Lee DC, et al. Longitudinal patterns of cardiorespiratory fitness predict the development of hypertension among men and women. [Published online ahead of print December 13, 2016]. Am J Med. doi:10.1016/j.amjmed.2016.11.017.
  3. Lee DC, Sui X, Church TS, Lavie CJ, Jackson AS, Blair SN. Changes in fitness and fatness on the development of cardiovascular disease risk factors hypertension, metabolic syndrome, and hypercholesterolemia. J Am Coll Cardiol. 2012;59(7):665-72.