Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland, USA.
Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland, USA Center for Healthcare Advancement & Outcomes & Miami Cardiac & Vascular Institute (MCVI), Baptist Health South Florida, Miami, FL, USA, Henry Ford Hospital, Detroit, Michigan, USA.
Heart. 2016 Mar;102(6):431-7. doi: 10.1136/heartjnl-2015-308537. Epub 2016 Jan 5.
Given the aging population and prevalence of sedentary behaviour in the USA, we investigated the impact of differences in exercise capacity associated with age on long-term outcomes. We derived fitness-associated 'biologic age' as a tool to encourage positive lifestyle changes.
This retrospective cohort study included 57085 patients without established coronary artery disease or heart failure (median age 53 years, 49% women, 29% black) who underwent clinically-referred treadmill stress testing at the Henry Ford Health System from 1991 to 2009. Patients were followed for 10.4±5 and 5.4±4 years for all-cause mortality and myocardial infarction (MI), respectively. We calculated hazard ratios associated with exercise capacity by age deciles using Cox regression models, adjusting for demographic and haemodynamic data, medical history, and medication use. Fitness-associated 'biologic age' was derived as the chronologic age with equivalent mortality or MI risk.
There were 6356 deaths and 1646 MIs during follow-up. Exercise capacity declined with increasing age. Higher exercise capacity was strongly associated with greater survival, with per-MET HR ranging from 0.82 (95% CI 0.78 to 0.86) in patients under 40 years of age, to 0.88 (95% CI 0.87 to 0.90) in those over 70 years of age. Biologic age varied markedly-up to three decades-within each age decile, and was a stronger predictor of mortality (C-statistic 0.81 vs 0.77) and MI (C-statistic 0.72 vs 0.68) than chronologic age.
Higher exercise capacity remained a powerful predictor of survival despite lower average exercise capacity at older ages, reinforcing its importance in patients of all ages. Fitness-associated biologic age was a stronger predictor of survival than chronologic age, and may be a useful clinical tool for facilitating patient discussions regarding the impact of exercise capacity on long-term risk.
鉴于美国人口老龄化和久坐行为的流行，我们研究了与年龄相关的运动能力差异对长期结局的影响。我们将与健康相关的“生物年龄”作为一种工具，鼓励积极的生活方式改变。
这项回顾性队列研究纳入了 57085 名无明确冠状动脉疾病或心力衰竭的患者（中位年龄 53 岁，49%为女性，29%为黑人），他们于 1991 年至 2009 年在亨利福特健康系统接受了临床推荐的跑步机压力测试。分别对所有患者进行了 10.4±5 年和 5.4±4 年的全因死亡率和心肌梗死（MI）随访。我们使用 Cox 回归模型按年龄十分位数计算了与运动能力相关的危险比，调整了人口统计学和血流动力学数据、病史和药物使用情况。与健康相关的“生物年龄”是根据死亡率或 MI 风险相等的实际年龄计算的。
随访期间发生 6356 例死亡和 1646 例 MI。运动能力随年龄增长而下降。更高的运动能力与更高的生存率密切相关，每增加 1 个代谢当量（MET）的 HR 范围为 40 岁以下患者的 0.82（95%CI 0.78 至 0.86），到 70 岁以上患者的 0.88（95%CI 0.87 至 0.90）。在每个年龄十分位内，生物年龄差异显著，相差 30 年，其对死亡率（C 统计量 0.81 与 0.77）和 MI（C 统计量 0.72 与 0.68）的预测能力均明显强于实际年龄。
尽管在年龄较大时的平均运动能力较低，但更高的运动能力仍然是生存的有力预测因素，这进一步强调了它在所有年龄段患者中的重要性。与健康相关的生物年龄是生存的一个更强的预测因素，比实际年龄更有用，可能是一种促进患者讨论运动能力对长期风险影响的有用临床工具。
