Life Sciences Division, Lawrence Berkeley National Laboratory, Donner Laboratory, Berkeley, California, USA.
Am J Cardiol. 2010 Jul 15;106(2):210-5. doi: 10.1016/j.amjcard.2010.03.017. Epub 2010 Jun 10.
Cardiorespiratory fitness has often been interpreted as a surrogate measurement of physical activity rather than an independent coronary heart disease (CHD) risk factor per se. Fitness is also known to be highly heritable, however, and rats bred selectively for treadmill endurance have low CHD risk phenotypes even in the absence of physical activity. Therefore, I assessed whether cardiorespiratory fitness predicted CHD independent of physical activity in 29,721 men followed prospectively for 7.7 years as part of the National Runners' Health Study. Specifically, CHD deaths and incident participant-reported physician-diagnosed myocardial infarction, revascularization procedures (coronary artery bypass grafting and percutaneous coronary intervention), and angina pectoris during follow-up were compared to baseline cardiorespiratory fitness (10-km footrace performance, meters/second). Nonfatal end points for the 80% of these men who provided follow-up questionnaires included 121 nonfatal myocardial infarctions, 317 revascularization procedures, and 81 angina pectora. The National Death Index identified 44 CHD deaths. Per meter/second increment in baseline fitness, men's risks decreased 54% for nonfatal myocardial infarction (p <0.0001), 44% for combined CHD deaths and nonfatal myocardial infarction (p = 0.0003), 53% for angina pectoris (p = 0.001), and 32% for revascularizations (p = 0.002). Adjustment for physical activity (kilometer/day run) had little effect on the per meter/second risk decreases for nonfatal myocardial infarction (from 64% to 63%), combined CHD deaths and nonfatal myocardial infarction (from 34% to 33%), angina pectoris (from 53% to 47%) or revascularizations (from 32% to 26%). In conclusion, the results suggest that cardiorespiratory fitness is a CHD risk factor, largely independent of physical activity, which warrants clinical screening.
心肺适能通常被解释为身体活动的替代测量指标，而不是独立的冠心病（CHD）风险因素。然而，心肺适能也被认为具有高度遗传性，经过选择性跑步机耐力培育的大鼠即使没有身体活动，其 CHD 风险表型也较低。因此，我评估了心肺适能是否可以预测 29721 名男性的 CHD，这些男性在作为国家跑步者健康研究一部分的前瞻性研究中随访了 7.7 年。具体而言，在随访期间，将 CHD 死亡和参与者报告的医生诊断心肌梗死、血管重建程序（冠状动脉旁路移植术和经皮冠状动脉介入治疗）以及心绞痛的发生与基线心肺适能（10 公里跑步成绩，米/秒）进行了比较。这些男性中有 80%提供了随访问卷，其中非致命终点包括 121 例非致命性心肌梗死、317 例血管重建程序和 81 例心绞痛。国家死亡索引确定了 44 例 CHD 死亡。在基线适应度每增加 1 米/秒，男性发生非致命性心肌梗死的风险降低 54%（p<0.0001），发生 CHD 死亡和非致命性心肌梗死的风险降低 44%（p=0.0003），发生心绞痛的风险降低 53%（p=0.001），发生血管重建的风险降低 32%（p=0.002）。对身体活动（每日跑步公里数）进行调整对非致命性心肌梗死（从 64%降至 63%）、CHD 死亡和非致命性心肌梗死（从 34%降至 33%）、心绞痛（从 53%降至 47%）或血管重建（从 32%降至 26%）的每米/秒风险降低的影响很小。总之，结果表明心肺适能是 CHD 的风险因素，在很大程度上独立于身体活动，这需要进行临床筛查。
