Mouaz H Al-Mallah1, Stephen P Juraschek2, Seamus Whelton2, Zeina A Dardari2, Jonathan K Ehrman3, Erin D Michos2, Roger S Blumenthal2, Khurram Nasir2, Waqas T Qureshi4, Clinton A Brawner3, Steven J Keteyian3, Michael J Blaha2. 1. Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI; King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Cardiac Center, Ministry of National Guard, Health Affairs, Riyadh, Saudi Arabia. Electronic address: mouaz74@gmail.com. 2. The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD. 3. Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI. 4. Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC.
Abstract
OBJECTIVE: To determine whether sex modifies the relationship between fitness and mortality. PATIENTS AND METHODS: We included 57,284 patients without coronary artery disease or heart failure who completed a routine treadmill exercise test between 1991 and 2009. We determined metabolic equivalent tasks (METs) and linked patient records with mortality data via the Social Security Death Index. Multivariable Cox regression was used to determine the association between sex, fitness, and all-cause mortality. RESULTS: There were 29,470 men (51.4%) and 27,814 women (48.6%) with mean ages of 53 and 54 years, respectively. Overall, men achieved 1.7 METs higher than women (P<.001). During median follow-up of 10 years, there were 6402 deaths. The mortality rate for men in each MET group was similar to that for women, who achieved an average of 2.6 METs lower (P=.004). Fitness was inversely associated with mortality in both men (hazard ratio [HR], 0.84 per 1 MET; 95% CI, 0.83-0.85) and women (HR, 0.83 per 1 MET; 95% CI, 0.81-0.84). This relationship did not plateau at high or low MET values. CONCLUSION: Although men demonstrated 1.7 METs higher than women, their survival was equivalent to that of women demonstrating 2.6 METs lower. Furthermore, higher MET values were associated with lower mortality for both men and women across the range of MET values. These findings are useful for tailoring prognostic information and lifestyle guidance to men and women undergoing stress testing.
OBJECTIVE: To determine whether sex modifies the relationship between fitness and mortality. PATIENTS AND METHODS: We included 57,284 patients without coronary artery disease or heart failure who completed a routine treadmill exercise test between 1991 and 2009. We determined metabolic equivalent tasks (METs) and linked patient records with mortality data via the Social Security Death Index. Multivariable Cox regression was used to determine the association between sex, fitness, and all-cause mortality. RESULTS: There were 29,470 men (51.4%) and 27,814 women (48.6%) with mean ages of 53 and 54 years, respectively. Overall, men achieved 1.7 METs higher than women (P<.001). During median follow-up of 10 years, there were 6402 deaths. The mortality rate for men in each MET group was similar to that for women, who achieved an average of 2.6 METs lower (P=.004). Fitness was inversely associated with mortality in both men (hazard ratio [HR], 0.84 per 1 MET; 95% CI, 0.83-0.85) and women (HR, 0.83 per 1 MET; 95% CI, 0.81-0.84). This relationship did not plateau at high or low MET values. CONCLUSION: Although men demonstrated 1.7 METs higher than women, their survival was equivalent to that of women demonstrating 2.6 METs lower. Furthermore, higher MET values were associated with lower mortality for both men and women across the range of MET values. These findings are useful for tailoring prognostic information and lifestyle guidance to men and women undergoing stress testing.
Authors: Martha Gulati; Leslee J Shaw; Ronald A Thisted; Henry R Black; C Noel Bairey Merz; Morton F Arnsdorf Journal: Circulation Date: 2010-06-28 Impact factor: 29.690
Authors: Mouaz H Al-Mallah; Steven J Keteyian; Clinton A Brawner; Seamus Whelton; Michael J Blaha Journal: Clin Cardiol Date: 2014-08 Impact factor: 2.882
Authors: Kenneth Rockwood; Susan E Howlett; Chris MacKnight; B Lynn Beattie; Howard Bergman; Réjean Hébert; David B Hogan; Christina Wolfson; Ian McDowell Journal: J Gerontol A Biol Sci Med Sci Date: 2004-12 Impact factor: 6.053
Authors: Martha Gulati; Dilip K Pandey; Morton F Arnsdorf; Diane S Lauderdale; Ronald A Thisted; Roxanne H Wicklund; Arfan J Al-Hani; Henry R Black Journal: Circulation Date: 2003-09-15 Impact factor: 29.690
Authors: Richard P Troiano; David Berrigan; Kevin W Dodd; Louise C Mâsse; Timothy Tilert; Margaret McDowell Journal: Med Sci Sports Exerc Date: 2008-01 Impact factor: 5.411
Authors: Xuemei Sui; Michael J LaMonte; James N Laditka; James W Hardin; Nancy Chase; Steven P Hooker; Steven N Blair Journal: JAMA Date: 2007-12-05 Impact factor: 56.272
Authors: Jacob P Kelly; Brian J Andonian; Mahesh J Patel; Zhen Huang; Linda K Shaw; Robert W McGarrah; Salvador Borges-Neto; Eric J Velazquez; William E Kraus Journal: Am Heart J Date: 2019-01-16 Impact factor: 4.749
Authors: Frank W Booth; Christian K Roberts; John P Thyfault; Gregory N Ruegsegger; Ryan G Toedebusch Journal: Physiol Rev Date: 2017-10-01 Impact factor: 37.312
Authors: Hesham M Eissa; Lu Lu; Malek Baassiri; Nickhill Bhakta; Matthew J Ehrhardt; Brandon M Triplett; Daniel M Green; Daniel A Mulrooney; Leslie L Robison; Melissa M Hudson; Kirsten K Ness Journal: Blood Adv Date: 2017-11-07
Authors: Minsuk Oh; Kelley Pettee Gabriel; David R Jacobs; Wei Bao; Gary L Pierce; Lucas J Carr; James G Terry; Jingzhong Ding; John Jeffrey Carr; Kara M Whitaker Journal: Am J Cardiol Date: 2022-03-20 Impact factor: 3.133
Authors: Victor W Zhong; Michael P Bancks; Pamela J Schreiner; Cora E Lewis; Lyn M Steffen; James B Meigs; Lauren A Schrader; Melanie Schorr; Karen K Miller; Stephen Sidney; Mercedes R Carnethon Journal: J Diabetes Complications Date: 2018-09-17 Impact factor: 3.219
Authors: Johannes Zeiher; Katherine J Ombrellaro; Nita Perumal; Thomas Keil; Gert B M Mensink; Jonas D Finger Journal: Sports Med Open Date: 2019-09-03