Clinical importance of non-participation in a maximal graded exercise test on risk of non-fatal and fatal cardiovascular events and all-cause mortality: CARDIA study.
Clinical importance of non-participation in a maximal graded exercise test on risk of non-fatal and fatal cardiovascular events and all-cause mortality: CARDIA study.
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DOI：
10.1016/j.ypmed.2017.10.025
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发表时间：
2018-01
影响因子：
5.1
通讯作者：
Jacobs DR Jr
中科院分区：
文献类型：
--
作者：
Pettee Gabriel K;Whitaker KM;Duprez D;Sternfeld B;Lewis CE;Sidney S;Knell G;Jacobs DR Jr
虽然最大分级运动测试 (GXT) 期间表现不佳可以预测心血管事件和过早死亡，但由于医学或非医学原因不参加 GXT 的潜在临床重要性目前尚不清楚。数据来自 4086 名和 3547 名年轻人冠状动脉风险发展 (CARDIA) 参与者，他们分别参加了 7 年级（25-37 岁）和/或 20 次检查（38-50 岁），其中包括 GXT。 Cox 比例风险模型用于检查 GXT 处置（分别在第 7 年和第 20 年）对非致命和致命心血管事件风险以及通过 28 年随访获得的全因死亡率的影响。在参加 7 年级和 20 年级考试的参与者中，分别有 12.9% 和 19.1% 的参与者没有按照协议进行或完成 GXT。调整后，与 GXT 完成者相比，因医疗原因错过第 20 年 GXT 的参与者心血管事件 [HR: 4.06 (95% CI: 1.43, 11.5)] 和全因死亡率 [HR: 3.07 (95% CI: 1.11, 12.3)] 的风险更高；因非医疗原因缺席第 20 年的参与者全因死亡风险也较高 [HR: 2.53 (95% CI: 1.61, 3.99)]。研究结果表明，无论医疗或非医疗原因，不参加 GXT 都是不良健康结果和过早死亡风险过高的重要预测因素。在错过 GXT 时，应进行额外的患者随访，包括确定潜在的干预目标（例如体重管理和戒烟计划）。
While poor performance during a maximal graded exercise test (GXT) predicts cardiovascular events and premature mortality, the potential clinical importance of non-participation in a GXT, either for medical or non-medical reasons, is currently unknown. Data are from 4086 and 3547 Coronary Artery Risk Development in Young Adults (CARDIA) participants who attended the Year 7 (ages 25–37 years) and/or 20 exams (ages 38–50 years), respectively, which included a GXT. Cox proportional hazard models were used to examine the effect of GXT disposition (at Year 7 and 20, separately) on risk of non-fatal and fatal cardiovascular events and all-cause mortality obtained through 28 years of follow-up. A GXT was not conducted or completed according to protocol in 12.9% and 19.1% of participants attending the Year 7 and 20 exams, respectively. After adjustment, participants who missed the Year 20 GXT for medical reasons had a higher risk of cardiovascular events [HR: 4.06 (95% CI: 1.43, 11.5)] and all-cause mortality [HR: 3.07 (95% CI: 1.11, 12.3)] compared to GXT completers; participants who missed at Year 20 for non-medical reasons also had higher risk of all-cause mortality [HR: 2.53 (95% CI: 1.61, 3.99)]. Findings suggest that non-participation in a GXT, regardless of medical or non-medical reason, to be an important predictor of excess risk of adverse health outcomes and premature mortality. Additional patient follow-up, including identification of potential targets for intervention (e.g., weight management and smoking cessation programs), should be conducted at the point of a missed GXT.
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DOI：
10.1016/0197-2456(91)90002-4
发表时间：
1991-02-01
期刊：
Controlled clinical trials
影响因子：
--
作者：
Cutter, G R;Burke, G L;Manolio, T A
通讯作者：
Manolio, T A
DOI：
10.1097/00008483-198911000-00003
发表时间：
1989-11-01
期刊：
Journal of cardiopulmonary rehabilitation
影响因子：
--
作者：
Jacobs, David R Jr;Hahn, Lorraine P;Sidney, Stephen
通讯作者：
Sidney, Stephen
DOI：
10.1161/01.atv.10.3.430
发表时间：
1990-05-01
期刊：
ARTERIOSCLEROSIS
影响因子：
--
作者：
MANOLIO, TA;SAVAGE, PJ;OBERMAN, A
通讯作者：
OBERMAN, A
影响因子：
37.8
作者：
Luepker, RV;Apple, FS;Tunstall-Pedoe, H
通讯作者：
Tunstall-Pedoe, H
影响因子：
24
作者：
Laukkanen, Jari A.;Makikallio, Timo H.;Kurl, Sudhir
通讯作者：
Kurl, Sudhir