Changes in Cardiorespiratory Fitness and Survival in Patients With or Without Cardiovascular Disease

Peter Kokkinos, Department of Cardiology, Washington, DC, Veterans Affairs Medical Center, Washington, DC, USA; Department of Kinesiology and Health, School of Arts and Sciences, Rutgers University, New Brunswick, New Jersey, USA; School of Medicine and Health Sciences, George Washington University, Washington, DC, USA. Electronic address: peter.kokkinos@va.gov.
Charles Faselis, School of Medicine and Health Sciences, George Washington University, Washington, DC, USA; Washington, DC, Veterans Affairs Medical Center, Washington, DC, USA.
Immanuel Babu Samuel, War Related Illness and Injury Study Center, Washington, DC, Veterans Affairs Medical Center, Washington, DC, USA; The Henry Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA.
Carl J. Lavie, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana. USA.
Jiajia Zhang, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Jose D. Vargas, Department of Cardiology, Washington, DC, Veterans Affairs Medical Center, Washington, DC, USA.
Andreas Pittaras, Department of Cardiology, Washington, DC, Veterans Affairs Medical Center, Washington, DC, USA; School of Medicine and Health Sciences, George Washington University, Washington, DC, USA.
Michael Doumas, Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina, USA.
Pamela Karasik, Washington, DC, Veterans Affairs Medical Center, Washington, DC, USA.
Hans Moore, Department of Cardiology, Washington, DC, Veterans Affairs Medical Center, Washington, DC, USA.
Michael Heimal, Department of Cardiology, Washington, DC, Veterans Affairs Medical Center, Washington, DC, USA.
Jonathan Myers, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA; Department of Cardiology, Stanford University, Stanford, California, USA.

Document Type

Journal Article

Publication Date

3-28-2023

Journal

Journal of the American College of Cardiology

Volume

81

Issue

12

DOI

10.1016/j.jacc.2023.01.027

Keywords

cardiovascular disease; fitness change; mortality

Abstract

BACKGROUND: The association between cardiorespiratory fitness (CRF) and mortality risk is based mostly on 1 CRF assessment. The impact of CRF change on mortality risk is not well-defined. OBJECTIVES: This study sought to evaluate changes in CRF and all-cause mortality. METHODS: We assessed 93,060 participants aged 30-95 years (mean 61.3 ± 9.8 years). All completed 2 symptom-limited exercise treadmill tests, 1 or more years apart (mean 5.8 ± 3.7 years) with no evidence of overt cardiovascular disease. Participants were assigned to age-specific fitness quartiles based on peak METS achieved on the baseline exercise treadmill test. Additionally, each CRF quartile was stratified based on CRF changes (increase, decrease, no change) observed on the final exercise treadmill test. Multivariable Cox models were used to estimate HRs and 95% CIs for all-cause mortality. RESULTS: During a median follow-up of 6.3 years (IQR: 3.7-9.9 years), 18,302 participants died with an average yearly mortality rate of 27.6 events per 1,000 person-years. In general, changes in CRF ≥1.0 MET were associated with inverse and proportionate changes in mortality risk regardless of baseline CRF status. For example, a decline in CRF of >2.0 METS was associated with a 74% increase in risk (HR: 1.74; 95% CI: 1.59-1.91) for low-fit individuals with CVD, and 69% increase (HR: 1.69; 95% CI: 1.45-1.96) for those without CVD. CONCLUSIONS: Changes in CRF reflected inverse and proportional changes in mortality risk for those with and without CVD. The impact of relatively small CRF changes on mortality risk has considerable clinical and public health significance.

Department

Medicine

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