Clinical Exercise Physiology Laboratory, Ball State University, Muncie, Indiana.
College of Health, Ball State University, Muncie, Indiana.
J Am Coll Cardiol. 2018 Nov 6;72(19):2283-2292. doi: 10.1016/j.jacc.2018.08.2166.
There is a well-established inverse relationship between cardiorespiratory fitness (CRF) and mortality. However, this relationship has almost exclusively been studied using estimated CRF.
This study aimed to assess the association of directly measured CRF, obtained using cardiopulmonary exercise (CPX) testing with all-cause, cardiovascular disease (CVD), and cancer mortality in apparently healthy men and women.
Participants included 4,137 self-referred apparently healthy adults (2,326 men, 1,811 women; mean age: 42.8 ± 12.2 years) who underwent CPX testing to determine baseline CRF. Participants were followed for 24.2 ± 11.7 years (1.1 to 49.3 years) for mortality. Cox-proportional hazard models were performed to determine the relationship of CRF (ml·kg·min) and CRF level (low, moderate, and high) with mortality outcomes.
During follow-up, 727 participants died (524 men, 203 women). CPX-derived CRF was inversely related to all-cause, CVD, and cancer mortality. Low CRF was associated with higher risk for all-cause (hazard ratio [HR]: 1.73; 95% confidence interval [CI]: 1.20 to 3.50), CVD (HR: 2.27; 95% CI: 1.20 to 3.49), and cancer (HR: 2.07; 95% CI: 1.18 to 3.36) mortality compared with high CRF. Further, each metabolic equivalent increment increase in CRF was associated with a 11.6%, 16.1%, and 14.0% reductions in all-cause, CVD, and cancer mortality, respectively.
Given the prognostic ability of CPX-derived CRF for all-cause and disease-specific mortality outcomes, its use should be highly considered for apparently healthy populations as it may help to improve the efficacy of the individualized patient risk assessment and guide clinical decisions.
心肺适能（CRF）与死亡率之间存在着明确的反比关系。然而，这一关系几乎完全是通过估计的 CRF 来研究的。
本研究旨在评估使用心肺运动（CPX）测试直接测量的 CRF 与所有原因、心血管疾病（CVD）和癌症死亡率之间的相关性，在看似健康的男性和女性中。
参与者包括 4137 名自我报告的看似健康的成年人（2326 名男性，1811 名女性；平均年龄：42.8±12.2 岁），他们接受了 CPX 测试以确定基线 CRF。参与者的随访时间为 24.2±11.7 年（1.1 至 49.3 年），以确定死亡率。使用 Cox 比例风险模型来确定 CRF（ml·kg·min）和 CRF 水平（低、中、高）与死亡率结果的关系。
在随访期间，727 名参与者死亡（524 名男性，203 名女性）。CPX 衍生的 CRF 与所有原因、CVD 和癌症死亡率呈负相关。低 CRF 与所有原因（风险比 [HR]：1.73；95%置信区间 [CI]：1.20 至 3.50）、CVD（HR：2.27；95% CI：1.20 至 3.49）和癌症（HR：2.07；95% CI：1.18 至 3.36）死亡率的风险增加相关，与高 CRF 相比。此外，CRF 每增加一个代谢当量增量，与所有原因、CVD 和癌症死亡率分别降低 11.6%、16.1%和 14.0%相关。
鉴于 CPX 衍生的 CRF 对所有原因和疾病特异性死亡率结果的预后能力，应高度考虑在看似健康的人群中使用，因为它可能有助于提高个体化患者风险评估的效果，并指导临床决策。
