Education Department.
Circ Heart Fail. 2013 Sep 1;6(5):898-905. doi: 10.1161/CIRCHEARTFAILURE.112.000088. Epub 2013 Jul 19.
We evaluated the individual and joint associations among cardiorespiratory fitness (CRF), body mass index, and heart failure (HF) mortality, as well as the additive effect of an increasing number of cardiovascular risk factors on HF mortality in fit versus unfit men.
A total of 44 674 men without a history of cardiovascular disease underwent a baseline examination between 1971 and 2010. Measures included body mass index and CRF quantified as duration of maximal treadmill exercise testing. Participants were divided into age-specific low, moderate, and high CRF categories. Hazard ratios were computed with Cox regression analysis. During a mean follow-up of 19.8±10.4 years, 153 HF deaths occurred. Adjusted hazard ratios across high, moderate, and low CRF categories were 1.0, 1.63, and 3.97, respectively, whereas those of normal, overweight, and obese body mass index categories were 1.0, 1.56, and 3.71, respectively (P for trend <0.0001 for each). When grouped into categories of fit and unfit (upper 80% and lower 20% of CRF distribution, respectively), hazard ratios were significantly lower in fit compared with unfit men in normal and overweight body mass index strata (P<0.002) but not in obese men. Within men matched for the same number of HF risk factors, fit men had significantly lower HF mortality than unfit men (P≤0.02).
Higher baseline CRF is associated with lower HF mortality risk in men, regardless of the number of HF risk factors present. Men should be counseled on physical activity with the goal of achieving at least a moderate level of CRF, thereby presumably decreasing their risk of HF mortality.
我们评估了心肺适能（CRF）、体重指数和心力衰竭（HF）死亡率之间的个体和联合关联，以及在健康和不健康男性中，心血管危险因素数量的增加对 HF 死亡率的附加影响。
共有 44674 名无心血管疾病病史的男性在 1971 年至 2010 年间接受了基线检查。测量包括体重指数和 CRF，其量化方法为最大跑步机运动测试的持续时间。参与者被分为特定年龄的低、中、高 CRF 类别。使用 Cox 回归分析计算危险比。在平均 19.8±10.4 年的随访期间，发生了 153 例 HF 死亡。高、中、低 CRF 类别对应的调整后的危险比分别为 1.0、1.63 和 3.97，而正常、超重和肥胖体重指数类别的危险比分别为 1.0、1.56 和 3.71（每个趋势的 P<0.0001）。当按健康和不健康（分别为 CRF 分布的上 80%和下 20%）分组时，在正常和超重体重指数分层中，健康男性的危险比明显低于不健康男性（P<0.002），但在肥胖男性中并非如此。在具有相同数量 HF 危险因素的男性中，健康男性的 HF 死亡率明显低于不健康男性（P≤0.02）。
较高的基线 CRF 与男性 HF 死亡率降低相关，无论存在多少 HF 危险因素。应建议男性进行身体活动，以达到至少中等水平的 CRF，从而可能降低 HF 死亡率的风险。
