Cardiology Division, Veterans Affairs Palo Alto Health Care System, CA; Cardiology Division, Stanford University, Stanford, CA.
Cardiology Division, Veterans Affairs Palo Alto Health Care System, CA.
Mayo Clin Proc. 2021 Feb;96(2):342-349. doi: 10.1016/j.mayocp.2020.04.049.
To determine population-attributable risk (PAR) and exposure impact number (EIN) for mortality associated with impaired cardiorespiratory fitness (CRF), physical inactivity, and other risk markers among veteran subjects.
The sample included 5890 male subjects (mean age 58±15) who underwent a maximal exercise test for clinical reasons between January 1, 1992, and December 31, 2014. All-cause mortality was the end point. Cox multivariable hazard models were performed to determine clinical, demographic, and exercise-test determinants of mortality. Population-attributable risks and EIN for the lowest quartile of CRF and for inactive behavior were analyzed, accounting for competing events.
There were 2728 deaths during a mean ± standard deviation follow-up period of 9.9±5.8 years. Having low CRF (<5.0 metabolic equivalents [METs]) was associated with an approximate 3-fold higher risk of mortality and a PAR of 12.9%. Each higher MET achieved on the treadmill was associated with a 15% reduction in mortality (hazard ratio [HR]=0.85; 95% confidence interval [CI], 0.83 to 0.88; P<.001). Nearly half the sample was inactive, and these subjects had a 23% higher mortality risk and a PAR of 8.8%. The least fit quartile (<5.0 METs) had relative risks of ≈6.0 compared with the most-fit group (HR=5.99; 95% CI, 4.9 to 7.3). The least-active tertile had ≈2-fold higher risks of mortality vs the most active subjects (HR=1.9; 95% CI, 0.91 to 4.1). The lowest EIN was observed for low fitness (3.8; 95% CI, 3.4 to 4.3, P<.001), followed by diabetes, smoking, hypertension, and physical inactivity (all P<.001 except for diabetes, P=.008).
Both higher CRF and physical activity provide protection against all-cause mortality in subjects referred for exercise testing for clinical reasons. Encouraging physical activity with the aim of increasing CRF would have a significant impact on reducing mortality.
确定与心肺功能受损、身体活动不足和其他风险标志物相关的死亡率的人群归因风险（PAR）和暴露影响数（EIN），研究对象为退伍军人。
该样本包括 5890 名男性受试者（平均年龄 58±15 岁），他们于 1992 年 1 月 1 日至 2014 年 12 月 31 日期间因临床原因进行了最大运动测试。全因死亡率是终点。采用 Cox 多变量风险模型确定与死亡率相关的临床、人口统计学和运动测试决定因素。分析了心肺功能最低四分位数和不活动行为的人群归因风险和 EIN，同时考虑了竞争事件。
在平均随访 9.9±5.8 年期间，有 2728 人死亡。心肺功能较低（<5.0 代谢当量[METs]）与死亡风险增加近 3 倍相关，PAR 为 12.9%。跑步机上每增加一个 MET，死亡率就会降低 15%（风险比[HR]=0.85；95%置信区间[CI]，0.83 至 0.88；P<.001）。近一半的样本不活动，这些受试者的死亡率风险增加 23%，PAR 为 8.8%。最低四分位数（<5.0 METs）的相对风险约为最适群组的 6.0（HR=5.99；95%CI，4.9 至 7.3）。最不活跃的 tertile 与最活跃的受试者相比，死亡率的风险增加了约 2 倍（HR=1.9；95%CI，0.91 至 4.1）。最低的 EIN 见于较低的体能（3.8；95%CI，3.4 至 4.3，P<.001），其次是糖尿病、吸烟、高血压和身体不活动（均<0.001，除了糖尿病，P=.008）。
在因临床原因接受运动测试的受试者中，较高的心肺功能和身体活动均可提供对全因死亡率的保护。鼓励以提高心肺功能为目的的身体活动将对降低死亡率产生重大影响。
