Zhu Yong-Jian, Fu Wan-Rong, Lu Wen-Jie, Wang Xu-Le, Wang Xi, Shan Ying-Guang, Zheng Xiao-Lin, Li Ran, Peng Meng, Pan Liang, Qiu Jing, Qin Xiao-Fei, Sun Guo-Ju, Wang Lu, Dong Jian-Zeng, Xiao Li-Li, Qiu Chun-Guang
Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Cardiology, Cardiovascular Institute of Zhengzhou University, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Am J Hypertens. 2024 Dec 16;38(1):63-71. doi: 10.1093/ajh/hpae137.
The non-exercise estimated cardiorespiratory fitness (eCRF) has been recognized as an important predictor of mortality among the general population. This study sought to evaluate the relationship between eCRF and mortality from all causes, cardiovascular disease (CVD), and cancer in hypertensive adults.
We included 27,437 adults with hypertension from the National Health and Nutrition Examination Survey (NHANES) III and 10 NHANES cycles from 1999 to 2018. Multivariate Cox proportional hazard models were used to assess the hazard ratios and 95% confidence intervals (CIs) of eCRF for mortality.
A total of 8,023 deaths were recorded throughout a median 8.6-year follow-up, including 2,338 from CVD, and 1,761 from cancer. The eCRF with per 1 metabolic equivalent increase was linked to decreased risk of all-cause (adjusted HR 0.78, 95% CI: 0.75-0.81) and CVD mortality (adjusted HR 0.79, 95% CI: 0.74-0.84), rather than cancer mortality (adjusted HR 0.94, 95% CI: 0.86-1.03). Moreover, a stronger protective effect of eCRF was observed for females (HR 0.66 (95% CI: 0.62-0.72) versus HR 0.78 (95% CI: 0.73-0.83), Pinteraction < 0.001 for all-cause mortality; HR 0.70 (95% CI: 0.61-0.80;) versus HR 0.82 (95% CI: 0.73-0.92), Pinteraction = 0.026 for CVD mortality) compared with males. Findings did not significantly differ in subgroup analyses and sensitivity analyses.
Among adults with hypertension, eCRF was inversely related to all-cause and CVD mortality, but not cancer mortality. A significant interaction effect existed between sex and eCRF. Further studies are needed to verify this association in different populations.
非运动估计心肺适能（eCRF）已被公认为普通人群死亡率的重要预测指标。本研究旨在评估高血压成年人中eCRF与全因死亡率、心血管疾病（CVD）死亡率和癌症死亡率之间的关系。
我们纳入了来自1999年至2018年的美国国家健康与营养检查调查（NHANES）III及10个NHANES周期的27437名高血压成年人。采用多变量Cox比例风险模型评估eCRF对死亡率的风险比和95%置信区间（CIs）。
在中位8.6年的随访期间共记录了8023例死亡，其中2338例死于CVD，1761例死于癌症。每增加1个代谢当量的eCRF与全因死亡风险降低（调整后HR 0.78，95% CI：0.75 - 0.81）和CVD死亡风险降低（调整后HR 0.79，95% CI：0.74 - 0.84）相关，而非癌症死亡风险（调整后HR 0.94，95% CI：0.86 - 1.03）。此外，与男性相比，女性中观察到eCRF具有更强的保护作用（全因死亡率：HR 0.66（95% CI：0.62 - 0.72）对HR 0.78（95% CI：0.73 - 0.83），P交互作用 < 0.001；CVD死亡率：HR 0.70（95% CI：0.61 - 0.80）对HR 0.82（95% CI：0.73 - 0.92），P交互作用 = 0.026）。亚组分析和敏感性分析结果无显著差异。
在高血压成年人中，eCRF与全因死亡率和CVD死亡率呈负相关，但与癌症死亡率无关。性别与eCRF之间存在显著的交互作用。需要进一步研究在不同人群中验证这种关联。
