Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD.
Department of Health, Physical Education, and Sport Studies, Winston-Salem State University, Winston-Salem, NC.
Mayo Clin Proc. 2021 Sep;96(9):2376-2385. doi: 10.1016/j.mayocp.2020.12.039. Epub 2021 Aug 5.
To determine whether fitness could improve mortality risk stratification among older adults compared with cardiovascular disease (CVD) risk factors.
We examined 6509 patients 70 years of age and older without CVD from the Henry Ford ExercIse Testing Project (FIT Project) cohort. Patients performed a physician-referred treadmill stress test between 1991 and 2009. Traditional categorical CVD risk factors (hypertension, hyperlipidemia, diabetes, and smoking) were summed from 0 to 3 or more. Fitness was grouped as low, moderate, and high (<6, 6 to 9.9, and ≥10 metabolic equivalents of task). All-cause mortality was ascertained through US Social Security Death Master files. We calculated age-adjusted mortality rates, multivariable adjusted Cox proportional hazards, and Kaplan-Meier survival models.
Patients had a mean age of 75±4 years, and 3385 (52%) were women; during a mean follow-up of 9.4 years, there were 2526 deaths. A higher fitness level (P<.001), not lower CVD risk factor burden (P=.31), was associated with longer survival. The age-adjusted mortality rate per 1000 person-years was 56.7 for patients with low fitness and 0 risk factors compared with 24.9 for high fitness and 3 or more risk factors. Among patients with 3 or more risk factors, the adjusted mortality hazard was 0.68 (95% CI, 0.61 to 0.76) for moderate and 0.51 (95% CI, 0.44 to 0.60) for high fitness compared with the least fit.
Among persons aged 70 years and older, there was no significant difference in survival of patients with 0 vs 3 or more risk factors, but a higher fitness level identified older persons with good long-term survival regardless of CVD risk factor burden.
确定与心血管疾病 (CVD) 风险因素相比，体能是否能改善老年人的死亡风险分层。
我们研究了来自 Henry Ford ExercIse Testing Project（FIT Project）队列的 6509 名 70 岁及以上无 CVD 的患者。患者于 1991 年至 2009 年期间接受了医生推荐的跑步机压力测试。传统的 CVD 风险因素（高血压、高血脂、糖尿病和吸烟）从 0 到 3 个或更多个进行累加。体能被分为低、中、高（<6、6 至 9.9 和≥10 代谢当量）。全因死亡率通过美国社会安全死亡主文件确定。我们计算了年龄调整后的死亡率、多变量调整后的 Cox 比例风险和 Kaplan-Meier 生存模型。
患者的平均年龄为 75±4 岁，3385 人（52%）为女性；平均随访 9.4 年后，有 2526 人死亡。更高的体能水平（P<.001），而不是更低的 CVD 风险因素负担（P=.31），与更长的生存时间相关。每 1000 人年的年龄调整死亡率为低体能和 0 个风险因素的患者为 56.7，而高体能和 3 个或更多风险因素的患者为 24.9。在有 3 个或更多风险因素的患者中，中度体能的调整死亡率危险度为 0.68（95%CI，0.61 至 0.76），而高体能的调整死亡率危险度为 0.51（95%CI，0.44 至 0.60），与最不适应的患者相比。
在 70 岁及以上的人群中，生存情况在无风险因素与 3 个或更多风险因素的患者之间没有显著差异，但更高的体能水平确定了无论 CVD 风险因素负担如何，长期生存良好的老年人。
