Prognostic impact of abdominal fat distribution and cardiorespiratory fitness in asymptomatic type 2 diabetics

BackgroundImpaired cardiorespiratory fitness (CRF) is a potent risk factor for mortality in diabetes, and may modify the relation between adiposity and mortality. We evaluated the interaction between CRF and abdominal adiposity distribution with all-cause mortality, myocardial infarction or stroke in patients with diabetes.MethodsWe studied 294 type 2 diabetics without known coronary artery disease. CRF was quantified in metabolic equivalents by maximal treadmill testing, and categorized as low CRF (first tertile) or high CRF (second and third tertiles). Abdominal fat was quantified as subcutaneous or visceral adipose tissue from non-enhanced computed tomography scans. Association of CRF, adiposity distribution and their interaction with all-cause mortality, myocardial infarction or stroke was assessed by Cox proportional-hazard models.ResultsThere were 31 (11%) events during 62 ± 12 months. Low CRF was significantly associated with event risk before and after adjustment for each measure of adiposity (haz...