Alexander Fardman1, Gabriel D Banschick2, Razi Rabia2, Ruth Percik3, Shlomo Segev4, Robert Klempfner5, Ehud Grossman2, Elad Maor6. 1. Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. 2. Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. 3. Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Institute of Endocrinology, Chaim Sheba Medical Center, Tel Hashomer, Israel. 4. Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Institute for Medical Screening, Chaim Sheba Medical Center, Tel Hashomer, Israel. 5. Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel; Institute for Medical Screening, Chaim Sheba Medical Center, Tel Hashomer, Israel. 6. Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. Electronic address: Elad.Maor@sheba.health.gov.il.
Abstract
BACKGROUND: Although cardiorespiratory fitness (CRF) is a strong independent predictor of adverse cardiovascular outcomes, it is not considered as a risk enhancer by current guidelines. METHODS: We evaluated asymptomatic self-referred adults aged 40 to 79 years of age, free of cardiovascular disease at baseline, who were screened annually and completed baseline exercise stress test. Baseline CRF was dichotomized into 2 groups: low (metabolic equivalents < 8) and high. The primary endpoint was the composite of death, nonfatal acute coronary syndrome, and stroke after excluding subjects diagnosed with metastatic cancer during follow-up. RESULTS: Study population included 15,445 subjects with median age of 49 years (interquartile range: 44-55). During median follow-up of 8 years 1362 (9%) subjects developed the study endpoint. Kaplan-Meier survival analysis showed that both fitness and atherosclerotic cardiovascular disease (ASCVD) were associated with developing of the study endpoint (P < 0.001 for both). Cox regression model with adjustment for ASCVD risk consistently showed that lower fitness was associated with a significant 23% higher risk to develop the study endpoint (P = 0.001). Continuous net reclassification improvement analysis showed an overall improvement of 11.4% (95% confidence interval, 8%-14.6%; P value < 0.001) in the accuracy of classification when fitness was added to the ASCVD model. CONCLUSIONS: Low CRF is a strong independent predictor of the cardiovascular morbidity and mortality in asymptomatic adults. Addition of fitness to the pooled cohort ASCVD risk significantly improves the accuracy of the model.
BACKGROUND: Although cardiorespiratory fitness (CRF) is a strong independent predictor of adverse cardiovascular outcomes, it is not considered as a risk enhancer by current guidelines. METHODS: We evaluated asymptomatic self-referred adults aged 40 to 79 years of age, free of cardiovascular disease at baseline, who were screened annually and completed baseline exercise stress test. Baseline CRF was dichotomized into 2 groups: low (metabolic equivalents < 8) and high. The primary endpoint was the composite of death, nonfatal acute coronary syndrome, and stroke after excluding subjects diagnosed with metastatic cancer during follow-up. RESULTS: Study population included 15,445 subjects with median age of 49 years (interquartile range: 44-55). During median follow-up of 8 years 1362 (9%) subjects developed the study endpoint. Kaplan-Meier survival analysis showed that both fitness and atherosclerotic cardiovascular disease (ASCVD) were associated with developing of the study endpoint (P < 0.001 for both). Cox regression model with adjustment for ASCVD risk consistently showed that lower fitness was associated with a significant 23% higher risk to develop the study endpoint (P = 0.001). Continuous net reclassification improvement analysis showed an overall improvement of 11.4% (95% confidence interval, 8%-14.6%; P value < 0.001) in the accuracy of classification when fitness was added to the ASCVD model. CONCLUSIONS: Low CRF is a strong independent predictor of the cardiovascular morbidity and mortality in asymptomatic adults. Addition of fitness to the pooled cohort ASCVD risk significantly improves the accuracy of the model.
Authors: Alis Bonsignore; Thomas H Marwick; Scott C Adams; Babitha Thampinathan; Emily Somerset; Eitan Amir; Mike Walker; Husam Abdel-Qadir; C Anne Koch; Heather J Ross; Anna Woo; Bernd J Wintersperger; Mark J Haykowsky; Paaladinesh Thavendiranathan Journal: JACC CardioOncol Date: 2021-11-16
Authors: Monira I Aldhahi; Wafa K Al Khalil; Rawan B Almutiri; Mada M Alyousefi; Bayader S Alharkan; Haya AnNasban Journal: Int J Environ Res Public Health Date: 2022-01-13 Impact factor: 3.390