Cardiorespiratory Fitness and Incidence of Major Adverse Cardiovascular Events in US Veterans: A Cohort Study

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• 作者：Peter F. Kokkinos ; PhD^a ; ^b ; ^c ; ^{peter.kokkinos@va.gov} ; Charles Faselis ; MD^a ; ^e ; Jonathan Myers ; PhD^f ; ^g ; Puneet Narayan ; MD^a ; Xuemei Sui ; MD ; PhD ; MPH^c ; Jiajia Zhang ; PhD^d ; Carl J. Lavie ; MD^h ; Hans Moore ; MD^a ; ^b ; Pamela Karasik ; MD^a ; ^b ; ^e ; Ross Fletcher ; MD^a ; ^b
• 关键词：BMI ; body mass index ; CABG ; coronary artery bypass graft ; CHF ; congestive heart failure ; CKD ; chronic kidney disease ; CRF ; cardiorespiratory fitness ; ETT ; exercise tolerance test ; HR ; hazard ratio ; MACE ; major adverse cardiovascular event ; MET ; metabolic equivalent ; MI ; myocardial infarction
• 刊名：Mayo Clinic Proceedings
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：92
• 期：1
• 页码：39-48
• 全文大小：476 K
• 卷排序：92

文摘

To assess the association between exercise capacity and the risk of major adverse cardiovascular events (MACEs).Patients and MethodsA symptom-limited exercise tolerance test was performed to assess exercise capacity in 20,590 US veterans (12,975 blacks and 7615 whites; mean ± SD age, 58.2±11.0 years) from the Veterans Affairs medical centers in Washington, District of Columbia, and Palo Alto, California. None had a history of MACE or evidence of ischemia at the time of or before their exercise tolerance test. We established quintiles of cardiorespiratory fitness (CRF) categories based on age-specific peak metabolic equivalents (METs) achieved. We also defined the age-specific MET level associated with no risk for MACE (hazard ratio [HR], 1.0) and formed 4 additional CRF categories based on METs achieved below (least fit and low fit) and above (moderately fit and highly fit) that level. Multivariate Cox models were used to estimate HR and 95% CIs for mortality across fitness categories.ResultsDuring follow-up (median, 11.3 years; range, 0.3-33.0 years), 2846 individuals experienced MACEs. The CRF-MACE association was inverse and graded. The risk for MACE declined precipitously for those with a CRF level of 6.0 METs or higher. When considering CFR categories based on the age-specific MET threshold, the risk increased for those in the 2 CFR categories below that threshold (HR, 1.95; 95% CI, 1.73-2.21 and HR, 1.41; 95% CI, 1.27-1.56 for the least-fit and low-fit individuals, respectively) and decreased for those above it (HR, 0.77; 95% CI, 0.68-0.87 and HR, 0.57; 95% CI, 0.48-0.67 for moderately fit and highly fit, respectively).ConclusionIncreased CRF is inversely and independently associated with the risk for MACE. When an age-specific MET threshold was defined, the risk for MACE increased significantly for those below that threshold and decreased for those above it (P<.001).