Department of Imaging, Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, California; Department of Medicine, Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, California.
Division of Cardiology, Mount Sinai St. Luke's Hospital, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York.
JACC Cardiovasc Imaging. 2017 Dec;10(12):1461-1468. doi: 10.1016/j.jcmg.2016.12.030. Epub 2017 May 17.
This study aims to assess the correlations among coronary artery calcium (CAC), self-reported exercise, and mortality in asymptomatic patients.
The interaction between reported exercise habits and CAC scores for predicting clinical risk is not yet well known.
We followed 10,690 asymptomatic patients who underwent CAC scanning. Patients were divided into 4 groups based on a single-item self-reported exercise. Mean follow-up was 8.9 ± 3.5 years for the occurrence of all-cause mortality (ACM).
Annualized ACM progressively increased with increasing CAC score (p < 0.001) and decreasing exercise (p < 0.001). Among patients with CAC scores of 0, ACM was low regardless of the amount of exercise. Among patients with CAC scores from 1 to 399, there was a stepwise increase in ACM for each reported decrement in exercise, and this difference was markedly more pronounced among patients with CAC scores ≥400. Compared with highly active patients with a CAC score of 0, highly sedentary patients with CAC scores ≥400 had a 3.1-fold increase (95% confidence interval: 1.35 to 7.11) in adjusted ACM risk. Our single-item physical activity questionnaire was also predictive of risk factors and clinical and lipid profile measurements.
In asymptomatic patients, self-reported exercise is a significant predictor of long-term outcomes. Prognostic value of the reported exercise is additive to the increasing degree of underlying atherosclerosis. Among patients with high CAC scores, exercise may play a protective role, whereas reported minimal or no exercise substantially increases clinical risk. Our results suggest there is clinical utility for the use of a simple single-item exercise questionnaire for such assessments.
本研究旨在评估无症状患者冠状动脉钙（CAC）、自我报告运动与死亡率之间的相关性。
报告的运动习惯与 CAC 评分预测临床风险之间的相互作用尚不清楚。
我们对 10690 名接受 CAC 扫描的无症状患者进行了随访。根据单一的自我报告运动项目，患者被分为 4 组。全因死亡率（ACM）的平均随访时间为 8.9±3.5 年。
随着 CAC 评分的增加（p<0.001）和运动量的减少（p<0.001），年化 ACM 逐渐增加。在 CAC 评分为 0 的患者中，无论运动量如何，ACM 均较低。在 CAC 评分为 1 至 399 的患者中，随着报告运动量的每一次减少，ACM 呈逐步增加，而在 CAC 评分≥400 的患者中，这种差异更为显著。与 CAC 评分为 0 且高度活跃的患者相比，CAC 评分≥400 且久坐不动的患者 ACM 风险增加了 3.1 倍（95%置信区间：1.35 至 7.11）。我们的单一项目体力活动问卷也可预测危险因素和临床及血脂谱测量结果。
在无症状患者中，自我报告的运动是长期预后的重要预测因素。报告运动的预后价值可与潜在动脉粥样硬化程度的增加相叠加。在 CAC 评分较高的患者中，运动可能起到保护作用，而报告的极少或不运动则会显著增加临床风险。我们的结果表明，使用简单的单一项目运动问卷进行此类评估具有临床意义。
