Research Division, The Cooper Institute, Dallas, Texas.
Research Division, The Cooper Institute, Dallas, Texas.
J Am Coll Cardiol. 2020 Apr 7;75(13):1538-1547. doi: 10.1016/j.jacc.2020.01.049.
An inverse association between cardiorespiratory fitness and mortality was robustly demonstrated 3 decades ago.
The purpose of this study was to determine whether significant advances in disease prevention, detection, and treatment since that time have modified this association.
A total of 47,862 men completed baseline examinations, including a maximal treadmill test. Cohort 1 (n = 24,475) was examined during 1971 to 1991 and followed for mortality through 1992. Cohort 2 (n = 23,387) was examined during 1992 to 2013 with follow-up through 2014. Men were categorized as low fit, moderate fit, or high fit using Cooper Clinic normative data. Hazard ratios (HRs) for all-cause, cardiovascular disease, and cancer mortality were determined across fitness categories in the 2 cohorts.
A significant inverse trend between fitness categories and all-cause (HR: 1.0, 0.60, and 0.53 in cohort 1 and HR: 1.0, 0.76, and 0.52 in cohort 2) and cardiovascular disease mortality (HR: 1.0, 0.55, and 0.43 in cohort 1 and HR: 1.0, 0.84, and 0.52 in cohort 2) was observed (p trend <0.001 for all). The trend across fitness categories and cancer mortality was significant for cohort 1 (HR: 1.0, 0.62, and 0.48; p < 0.001), but not for cohort 2 (HR: 1.0, 1.08, and 0.74; p = 0.19). HRs for all-cause mortality were 0.86 (95% confidence interval: 0.82 to 0.90) and 0.87 (95% confidence interval: 0.83 to 0.91) per 1-MET increment in fitness for cohorts 1 and 2, respectively (p < 0.001 for both). Similar values were seen for cardiovascular disease and cancer mortality.
Despite significant advances in disease prevention, detection, and treatment since fitness was first shown to be associated with mortality, the inverse association between fitness and mortality remains consistent in a contemporary cohort of men.
三十年前，人们就已经强有力地证明了心肺适能与死亡率之间呈负相关关系。
本研究旨在确定自那时以来，在疾病预防、检测和治疗方面取得的显著进展是否改变了这种关联。
共有 47862 名男性完成了基线检查，包括最大跑步机测试。队列 1（n=24475）于 1971 年至 1991 年期间接受检查，并在 1992 年之前进行了死亡率随访。队列 2（n=23387）于 1992 年至 2013 年期间接受检查，并在 2014 年之前进行了随访。根据库珀诊所的标准数据，男性被分为低适能、中适能和高适能。在这两个队列中，根据适能类别确定全因、心血管疾病和癌症死亡率的风险比（HR）。
在两个队列中，都观察到适能类别与全因（HR：1.0、0.60 和 0.53 在队列 1 中，HR：1.0、0.76 和 0.52 在队列 2 中）和心血管疾病死亡率（HR：1.0、0.55 和 0.43 在队列 1 中，HR：1.0、0.84 和 0.52 在队列 2 中）呈显著负相关趋势（p 趋势<0.001）。队列 1 中，适能类别与癌症死亡率呈显著相关（HR：1.0、0.62 和 0.48；p<0.001），但队列 2 中无显著相关性（HR：1.0、1.08 和 0.74；p=0.19）。队列 1 和 2 中，每增加 1 个代谢当量（MET），全因死亡率的 HR 分别为 0.86（95%置信区间：0.82 至 0.90）和 0.87（95%置信区间：0.83 至 0.91）（均 p<0.001）。心血管疾病和癌症死亡率也有类似的值。
尽管自首次证明心肺适能与死亡率相关以来，在疾病预防、检测和治疗方面取得了重大进展，但在当代男性队列中，心肺适能与死亡率之间的负相关关系仍然保持一致。
