Physical Fitness and Risk for Heart Failure and Coronary Artery Disease

Circulation: Heart Failure - Tập 6 Số 4 - Trang 627-634 - 2013
Jarett D. Berry1, Ambarish Pandey1, Ang Gao1, David Léonard2,1, Ramin Farzaneh‐Far1, Colby Ayers1, Laura F. DeFina1, Benjamin L. Willis1
1From the Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX (J.D.B., A.P., A.G., C.A.); Cooper Institute, Dallas, TX (D.L., L.D., B.W.); and Division of Cardiology, San Francisco General Hospital, University of California, San Francisco, CA.
2Clinical Sciences

Tóm tắt

Background— Multiple studies have demonstrated strong associations between cardiorespiratory fitness and lower cardiovascular disease mortality. In contrast, little is known about associations of fitness with nonfatal cardiovascular events. Methods and Results— Linking individual participant data from the Cooper Center Longitudinal Study with Medicare claims files, we studied 20 642 participants (21% women) with fitness measured at the mean age of 49 years and who survived to receive Medicare coverage from 1999 to 2009. Fitness was categorized into age- and sex-specific quintiles (Q) according to Balke protocol treadmill time with Q1 as low fitness. Fitness was also estimated in metabolic equivalents according to treadmill time. Associations between midlife fitness and hospitalizations for heart failure and acute myocardial infarction after the age of 65 years were assessed by applying a proportional hazards model to the multivariate failure time data. After 133 514 person-years of Medicare follow-up, we observed 1051 hospitalizations for heart failure and 832 hospitalizations for acute myocardial infarction. Compared with high fitness (Q4–5), low fitness (Q1) was associated with a higher rate of heart failure hospitalization (14.3% versus 4.2%) and hospitalization for myocardial infarction (9.7% versus 4.5%). After multivariable adjustment for baseline age, blood pressure, diabetes mellitus, body mass index, smoking status, and total cholesterol, a 1 unit greater fitness level in metabolic equivalents achieved in midlife was associated with ≈20% lower risk for heart failure hospitalization after the age of 65 years (men: hazard ratio [95% confidence intervals], 0.79 [0.75–0.83]; P <0.001 and women: 0.81 [0.68–0.96]; P =0.01) but just a 10% lower risk for acute myocardial infarction in men (0.91 [0.87–0.95]; P <0.001) and no association in women (0.97 [0.83–1.13]; P =0.68). Conclusions— Fitness in healthy, middle-aged adults is more strongly associated with heart failure hospitalization than acute myocardial infarction outcomes decades later in older age.

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Tài liệu tham khảo

10.1249/00005768-199301000-00010

10.1249/MSS.0b013e318258b443

10.1001/jama.1995.03520380029031

10.1001/jama.1989.03430170057028

10.1056/NEJM198811243192104

10.1016/S0140-6736(98)02268-5

10.1056/NEJMoa011858

10.1001/jama.2009.681

10.1016/j.jacc.2010.10.056

10.1056/NEJM199406023302201

10.1001/jama.1984.03350040017014

10.1001/jama.290.23.3092

10.7326/0003-4819-134-1-200101020-00008

10.1016/j.atherosclerosis.2008.06.012

10.1016/0021-9150(94)05416-G

10.1001/jama.1995.03520410065028

10.1161/circulationaha.110.973784

Saltin B, Blomqvist G, Mitchell JH, Johnson RL, Wildenthal K, Chapman CB. Response to exercise after bed rest and after training. Circulation. 1968;38:VII1–VII78.

10.1056/NEJMra072139

10.1161/01.cir.0000142863.71285.74

10.1001/archinternmed.2012.3400

10.1016/S0002-8703(76)80401-2

10.1093/biomet/68.2.373

10.1080/01621459.1989.10478874

10.1161/cir.0b013e3182009701

10.1016/j.jacc.2008.03.061

10.1056/NEJMe020115

10.1093/aje/kwp412

10.7326/0003-4819-130-2-199901190-00002

10.1056/NEJMcp022709

10.1016/0002-9149(87)91136-2

10.1161/circulationaha.107.734764

10.1161/circulationaha.105.542993

10.1093/aje/kwm031

10.1161/CIRCULATIONAHA.110.010710

10.1111/j.1751-7133.2010.00189.x

10.1016/j.jacc.2010.05.035

10.1161/CIRCULATIONAHA.109.887893

10.1161/circulationaha.108.807289

10.1001/archinte.161.7.996

10.1056/NEJM199810153391606

10.1001/archinte.165.9.1028

10.1016/j.jada.2005.08.008

10.1001/jama.292.22.2743

10.1016/S0195-668X(03)00114-3

10.1001/archinte.160.2.197

10.1111/j.1475-6773.2004.00321.x

10.1097/MLR.0b013e318197b104

10.1016/j.ahj.2004.02.013

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Circulation: Heart Failure

Tập 6 Số 4

627-634

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