Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
Eur J Heart Fail. 2014 Feb;16(2):180-8. doi: 10.1111/ejhf.37. Epub 2013 Dec 14.
To examine the relationship between cardiorespiratory fitness (CRF) and risk of incident heart failure (HF).
Cardiorespiratory fitness, as measured by maximal oxygen uptake (VO2 max), was assessed at baseline in a prospective cohort of 1873 men aged 42-61 years without HF or chronic respiratory disease. During a mean follow-up of 20.4 years, 152 incident HF events were recorded. Within-person variability was calculated using data from repeat measurements taken 11 years apart. The age-adjusted hazard ratio (HR) per unit increase (1 mL/kg/min of VO2 max) in CRF was 0.89 [95% confidence interval (CI) 0.86-0.93], which was minimally attenuated to 0.94 (95% CI 0.90-0.98) after further adjustment for established HF risk factors (body mass index, systolic blood pressure, history of cardiovascular disease, diabetes, heart rate, and LV hypertrophy) and incident coronary events as a time-varying covariate. In a comparison of extreme quartiles of CRF levels (VO2 max ≥35.4 vs. ≤25.7 mL/kg/min), the corresponding HRs were 0.27 (0.15-0.50) and 0.48 (0.25-0.92), respectively. Each 1 MET (metabolic equivalent of oxygen consumption) increment in CRF was associated with a 21% (7-33%) reduction in multivariable adjusted risk of HF. Addition of CRF to a HF risk prediction model containing established risk factors did not significantly improve risk discrimination (C-index change = 0.0164, P = 0.07).
In this Finnish population, there is a strong, inverse, and independent association between long-term CRF and HF risk, consistent with a dose-response relationship. The protective effect of CRF on HF risk warrants further evaluation.
研究心肺适能（CRF）与心力衰竭（HF）发病风险之间的关系。
在一项前瞻性队列研究中，对 1873 名年龄在 42-61 岁、无 HF 或慢性呼吸系统疾病的男性，在基线时采用最大摄氧量（VO2 max）评估心肺适能。在平均 20.4 年的随访期间，记录到 152 例 HF 事件。使用相隔 11 年的重复测量数据计算个体内变异性。CRF 每增加（VO2 max 增加 1 mL/kg/min）的年龄校正危险比（HR）为 0.89（95%置信区间 [CI]，0.86-0.93），进一步调整 HF 已知危险因素（体重指数、收缩压、心血管疾病史、糖尿病、心率和左心室肥厚）和作为时变协变量的新发冠状动脉事件后，HR 最小衰减至 0.94（95% CI，0.90-0.98）。在 CRF 水平（VO2 max ≥35.4 与 ≤25.7 mL/kg/min）的极端四分位比较中，相应的 HR 分别为 0.27（0.15-0.50）和 0.48（0.25-0.92）。CRF 每增加 1 MET（耗氧量代谢当量），多变量校正 HF 风险降低 21%（7%-33%）。在包含已知危险因素的 HF 风险预测模型中加入 CRF 并不会显著提高风险区分度（C 指数变化=0.0164，P=0.07）。
在这项芬兰人群研究中，长期 CRF 与 HF 风险之间存在强烈、反向和独立的关联，符合剂量反应关系。CRF 对 HF 风险的保护作用值得进一步评估。
