Age-dependent prognostic value of exercise capacity and derivation of fitness-associated biologic age
Age-dependent prognostic value of exercise capacity and derivation of fitness-associated biologic age
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DOI：
10.1136/heartjnl-2015-308537
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发表时间：
2016-03-01
期刊：
影响因子：
5.7
通讯作者：
Al-Mallah, Mouaz H.
中科院分区：
文献类型：
--
作者：
Blaha, Michael J.;Hung, Rupert K.;Al-Mallah, Mouaz H.
目的鉴于美国人口老龄化和久坐行为的盛行，我们调查了与年龄相关的运动能力差异对长期结果的影响。我们得出了与健康相关的生物年龄作为鼓励积极生活方式改变的工具。方法这项回顾性队列研究包括1991年至2009年在亨利福特健康系统接受临床参考跑步机负荷测试的57085名没有确诊的冠状动脉疾病或心力衰竭的患者(中位年龄53岁，49%女性，29%黑人)。分别随访10.4+/-5年和5.4+/-4年的全因死亡率和心肌梗死(MI)。我们使用COX回归模型，根据人口统计学和血流动力学数据、病史和用药情况进行调整，计算出与运动能力相关的风险比。健康相关的“生物年龄”是指具有相同死亡率或心肌梗死风险的实际年龄。结果在随访期间有6356例死亡和1646例失访。运动能力随年龄增长而下降。较高的运动量与较高的存活率密切相关，40岁以下患者的人均心率从0.82(95%可信区间0.78~0.86)到70岁以上患者的0.88(95%可信区间0.87~0.90)。在每十岁的年龄范围内，生物年龄差异显著--长达30年--并且是死亡率(C-统计量0.81比0.77)和MI(C-统计量0.72比0.68)的更强的预测因子。结论尽管老年人的平均运动量较低，但较高的运动量仍然是一个强大的生存预测因子，加强了它在所有年龄段患者中的重要性。与健康相关的生物年龄是比实际年龄更强的生存预测因子，并且可能是促进患者讨论运动能力对长期风险的影响的有用的临床工具。
Objective Given the aging population and prevalence of sedentary behaviour in the USA, we investigated the impact of differences in exercise capacity associated with age on long-term outcomes. We derived fitness-associated 'biologic age' as a tool to encourage positive lifestyle changes.Methods This retrospective cohort study included 57 085 patients without established coronary artery disease or heart failure (median age 53 years, 49% women, 29% black) who underwent clinically-referred treadmill stress testing at the Henry Ford Health System from 1991 to 2009. Patients were followed for 10.4 +/- 5 and 5.4 +/- 4 years for all-cause mortality and myocardial infarction (MI), respectively. We calculated hazard ratios associated with exercise capacity by age deciles using Cox regression models, adjusting for demographic and haemodynamic data, medical history, and medication use. Fitness-associated 'biologic age' was derived as the chronologic age with equivalent mortality or MI risk.Results There were 6356 deaths and 1646 MIs during follow-up. Exercise capacity declined with increasing age. Higher exercise capacity was strongly associated with greater survival, with per-MET HR ranging from 0.82 (95% CI 0.78 to 0.86) in patients under 40 years of age, to 0.88 (95% CI 0.87 to 0.90) in those over 70 years of age. Biologic age varied markedly-up to three decades-within each age decile, and was a stronger predictor of mortality (C-statistic 0.81 vs 0.77) and MI (C-statistic 0.72 vs 0.68) than chronologic age.Conclusions Higher exercise capacity remained a powerful predictor of survival despite lower average exercise capacity at older ages, reinforcing its importance in patients of all ages. Fitness-associated biologic age was a stronger predictor of survival than chronologic age, and may be a useful clinical tool for facilitating patient discussions regarding the impact of exercise capacity on long-term risk.