Khan Hassan, Jaffar Nabil, Rauramaa Rainer, Kurl Sudhir, Savonen Kai, Laukkanen Jari A
Emory University, Atlanta, GA.
Emory University, Atlanta, GA.
Am Heart J. 2017 Feb;184:55-61. doi: 10.1016/j.ahj.2016.10.019. Epub 2016 Nov 2.
To examine the prognostic value of cardiorespiratory fitness (CRF) with risk of first major nonfatal myocardial infarction (MI), stroke, and heart failure (HF) events.
Cardiorespiratory fitness, as measured by maximal oxygen uptake, was assessed at baseline in a prospective cohort of 2,089 men aged 42 to 61years.
During a mean (SD) follow-up of 19.1(8.4) years, 522 nonfatal acute MI events, 198 acute all-cause nonfatal stroke events, and 221 nonfatal HF events were recorded. The hazard ratio per 1-metabolic-equivalent increase in CRF was 0.93 (95% CI 0.88-0.97) for nonfatal MI, 0.94 (95% CI0.87-1.01) for nonfatal stroke, and 0.84 (95% CI 0.78-0.91) for nonfatal HF events after adjustment for cardiovascular risk factors (age, systolic blood pressure, body mass index, history of cardiovascular disease, diabetes, smoking, alcohol use, serum creatinine, low-density lipoprotein levels, physical activity, and socioeconomic status). Further adjustment for left ventricular hypertrophy and resting heart rate did not attenuate these associations. Addition of CRF to conventional cardiovascular disease risk factors significantly improved both discrimination (C index) and category free net reclassification index (cf-NRI) for nonfatal MI (change in C index, 0.015 [95% CI 0.010-0.020] and change in cf-NRI 0.27, P<.01) and HF (change in C index 0.040 [95% CI 0.010-0.060] and change in cf-NRI 0.88, P<.01).
In this Finnish population, there is a strong, inverse, and independent association between CRF and acute nonfatal MI and HF risk.
探讨心肺适能（CRF）对首次发生重大非致命性心肌梗死（MI）、中风和心力衰竭（HF）事件风险的预后价值。
在一个由2089名年龄在42至61岁之间的男性组成的前瞻性队列中，于基线时通过最大摄氧量评估心肺适能。
在平均（标准差）19.1（8.4）年的随访期间，记录了522例非致命性急性心肌梗死事件、198例急性全因非致命性中风事件和221例非致命性心力衰竭事件。在调整心血管危险因素（年龄、收缩压、体重指数、心血管疾病史、糖尿病、吸烟、饮酒、血清肌酐、低密度脂蛋白水平、身体活动和社会经济状况）后，CRF每增加1个代谢当量的风险比，非致命性心肌梗死为0.93（95%置信区间0.88 - 0.97），非致命性中风为0.94（9%置信区间0.87 - 1.01），非致命性心力衰竭为0.84（95%置信区间0.78 - 0.91）。进一步调整左心室肥厚和静息心率并未减弱这些关联。将CRF添加到传统心血管疾病危险因素中，显著改善了非致命性心肌梗死（C指数变化，0.015 [95%置信区间0.010 - 0.020]，无类别净重新分类指数[cf - NRI]变化0.27，P <.01）和心力衰竭（C指数变化0.040 [95%置信区间0.010 - 0.060]，cf - NRI变化0.88，P <.01）的辨别力（C指数）和无类别净重新分类指数。
在这个芬兰人群中，CRF与急性非致命性心肌梗死和心力衰竭风险之间存在强烈、反向且独立的关联。
