Cardiorespiratory Fitness and Risk of Cardiovascular Events and Mortality in Middle Age Patients without Known Cardiovascular Disease

Author:

Aker Amir1,Saliba Walid23,Bahouth Fadel4,Naoum Ibrahim1,Zafrir Barak13ORCID

Affiliation:

1. Department of Cardiology, Lady Davis Carmel Medical Center, Haifa 3436212, Israel

2. Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa 3436212, Israel

3. Faculty of Medicine, Technion—Israel Institute of Medicine, Haifa 3525433, Israel

4. Department of Cardiology, EMMS Nazareth Hospital, Nazareth 16100, Israel

Abstract

Background: Low cardiorespiratory fitness is an established risk predictor for chronic non-communicable diseases. We aimed to investigate the prognostic significance of fitness level on the risk of major adverse cardiac events (MACE, the composite of myocardial infarction, stroke, or all-cause death), in a contemporary cohort of middle-aged subjects without cardiovascular disease. Methods: Retrospective analysis of patients aged 40–60 years without a history of cardiovascular disease. Degree of fitness was determined according to a graded, maximal treadmill exercise stress testing (EST) time achieved, classified into age- and sex-specific quintiles (Q), and categorized as low (Q1), moderate (Q2–Q4) or high (Q5) fitness groups. A multivariable Cox proportional hazard regression model was used to assess the association of fitness level with the risk of MACE. Results: A total of 6836 patients were included, of which 44.5% were women, and the mean age was 52 years. Overall, 289 MACE events occurred during a median follow-up of 7 years. Level of fitness was inversely associated with the presence of cardiovascular risk factors. The multivariable adjusted hazard ratio (95% confidence interval) for MACE was 1.65 (1.12–2.44) and 2.17 (1.40–3.38) in those at moderate and low fitness levels, compared to the high-fitness group (reference), respectively. For each decrease of one metabolic equivalent (MET) unit achieved at peak exercise, the relative risk for MACE increased by 18%. The association between low fitness and MACE was not modified by other risk factors (P-for-interaction non-significant). Conclusions: Low fitness level, as captured by a maximal treadmill EST, is an independent risk predictor for MACE among middle-age individuals without known cardiovascular disease. The association of low fitness with high burden of cardiometabolic risk factors highlight the importance of lifestyle intervention in this patient population.

Publisher

MDPI AG

Subject

General Medicine

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