Cardiorespiratory Fitness and Mortality in Healthy Men and Women
Cardiorespiratory Fitness and Mortality in Healthy Men and Women
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DOI：
10.1016/j.jacc.2018.08.2166
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发表时间：
2018-11-06
影响因子：
24
通讯作者：
Kaminsky, Leonard A.
中科院分区：
文献类型：
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作者：
Imboden, Mary T.;Harber, Matthew P.;Kaminsky, Leonard A.
背景：心肺适能（CRF）与死亡率之间存在明确的负相关关系。然而，这种关系几乎完全是用估计的CRF进行研究的。结论这项研究旨在评估直接测量的CRF与所有原因，心血管疾病（CVD）和癌症死亡率在明显健康的男性和女性中的关系，使用心肺运动（CPX）测试获得。（2，326名男性，1，811名女性;平均年龄：42.8 ± 12.2岁），接受CPX检测以确定基线CRF。对参与者的死亡率进行了24.2 +/- 11.7年（1.1至49.3年）的随访。Cox比例风险模型用于确定CRF（ml . kg（-1）.min（-1））和CRF水平（低、中、高）与死亡率的关系。CPX衍生的CRF与全因、CVD和癌症死亡率呈负相关。与高CRF相比，低CRF与全因死亡率（风险比[HR]：1.73; 95%置信区间[CI]：1.20至3.50）、CVD（HR：2.27; 95% CI：1.20至3.49）和癌症（HR：2.07; 95% CI：1.18至3.36）的风险较高相关。此外，CRF中每个代谢当量增量的增加分别与全因、CVD和癌症死亡率的11.6%、16.1%和14.0%的降低相关。应高度考虑将其用于明显健康的人群，因为它可能有助于提高个性化患者风险评估的功效，并指导临床决策。(c)2018年由美国心脏病学会基金会。
BACKGROUND There is a well-established inverse relationship between cardiorespiratory fitness (CRF) and mortality. However, this relationship has almost exclusively been studied using estimated CRF.OBJECTIVES This study aimed to assess the association of directly measured CRF, obtained using cardiopulmonary exercise (CPX) testing with all-cause, cardiovascular disease (CVD), and cancer mortality in apparently healthy men and women.METHODS Participants included 4,137 self-referred apparently healthy adults (2,326 men, 1,811 women; mean age: 42.8 +/- 12.2 years) who underwent CPX testing to determine baseline CRF. Participants were followed for 24.2 +/- 11.7 years (1.1 to 49.3 years) for mortality. Cox-proportional hazard models were performed to determine the relationship of CRF (ml . kg(-1).min(-1)) and CRF level (low, moderate, and high) with mortality outcomes.RESULTS During follow-up, 727 participants died (524 men, 203 women). CPX-derived CRF was inversely related to all-cause, CVD, and cancer mortality. Low CRF was associated with higher risk for all-cause (hazard ratio [HR]: 1.73; 95% confidence interval [CI]: 1.20 to 3.50), CVD (HR: 2.27; 95% CI: 1.20 to 3.49), and cancer (HR: 2.07; 95% CI: 1.18 to 3.36) mortality compared with high CRF. Further, each metabolic equivalent increment increase in CRF was associated with a 11.6%, 16.1%, and 14.0% reductions in all-cause, CVD, and cancer mortality, respectively.CONCLUSIONS Given the prognostic ability of CPX-derived CRF for all-cause and disease-specific mortality outcomes, its use should be highly considered for apparently healthy populations as it may help to improve the efficacy of the individualized patient risk assessment and guide clinical decisions. (c) 2018 by the American College of Cardiology Foundation.