心肺适能与心血管疾病死亡风险的分类。
Cardiorespiratory fitness and classification of risk of cardiovascular disease mortality.
机构信息
University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9047, USA.
出版信息
Circulation. 2011 Apr 5;123(13):1377-83. doi: 10.1161/CIRCULATIONAHA.110.003236. Epub 2011 Mar 21.
BACKGROUND
Cardiorespiratory fitness (fitness) is associated with cardiovascular disease (CVD) mortality. However, the extent to which fitness improves risk classification when added to traditional risk factors is unclear.
METHODS AND RESULTS
Fitness was measured by the Balke protocol in 66 371 subjects without prior CVD enrolled in the Cooper Center Longitudinal Study between 1970 and 2006; follow-up was extended through 2006. Cox proportional hazards models were used to estimate the risk of CVD mortality with a traditional risk factor model (age, sex, systolic blood pressure, diabetes mellitus, total cholesterol, and smoking) with and without the addition of fitness. The net reclassification improvement and integrated discrimination improvement were calculated at 10 and 25 years. Ten-year risk estimates for CVD mortality were categorized as <1%, 1% to <5%, and ≥5%, and 25-year risk estimates were categorized as <8%, 8% to 30%, and ≥30%. During a median follow-up period of 16 years, there were 1621 CVD deaths. The addition of fitness to the traditional risk factor model resulted in reclassification of 10.7% of the men, with significant net reclassification improvement at both 10 years (net reclassification improvement=0.121) and 25 years (net reclassification improvement=0.041) (P<0.001 for both). The integrated discrimination improvement was 0.010 at 10 years (P<0.001), and the relative integrated discrimination improvement was 29%. Similar findings were observed for women at 25 years.
CONCLUSIONS
A single measurement of fitness significantly improves classification of both short-term (10-year) and long-term (25-year) risk for CVD mortality when added to traditional risk factors.
背景
心肺适能（fitness）与心血管疾病（CVD）死亡率相关。然而，在加入传统危险因素后，fitness 改善风险分类的程度尚不清楚。
方法和结果
在 1970 年至 2006 年间参加库珀中心纵向研究的 66371 例无先前 CVD 的受试者中，通过 Balke 方案测量了 fitness；随访时间延长至 2006 年。使用 Cox 比例风险模型，根据传统危险因素模型（年龄、性别、收缩压、糖尿病、总胆固醇和吸烟）和是否加入 fitness，估计 CVD 死亡率的风险。在 10 年和 25 年时计算净重新分类改善和综合判别改善。10 年 CVD 死亡率风险估计分为<1%、1%<5%和≥5%，25 年风险估计分为<8%、8%30%和≥30%。在中位数为 16 年的随访期间，有 1621 例 CVD 死亡。将 fitness 加入传统危险因素模型后，男性中有 10.7%的人得到重新分类，在 10 年（净重新分类改善=0.121）和 25 年（净重新分类改善=0.041）时均有显著的净重新分类改善（均<0.001）。10 年时的综合判别改善为 0.010（<0.001），相对综合判别改善为 29%。在女性中，25 年时也观察到了类似的发现。
结论
在加入传统危险因素后，单次测量 fitness 可显著改善短期（10 年）和长期（25 年）CVD 死亡率风险的分类。
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