Elsevier

American Heart Journal

Volume 170, Issue 2, August 2015, Pages 390-399.e6
American Heart Journal

Clinical Investigation
Prevention and Rehabilitation
Cardiorespiratory fitness attenuates risk for major adverse cardiac events in hyperlipidemic men and women independent of statin therapy: The Henry Ford ExercIse Testing Project

https://doi.org/10.1016/j.ahj.2015.04.030Get rights and content

Aims

We sought to evaluate the effect of cardiorespiratory fitness (CRF) in predicting mortality, myocardial infarction (MI), and revascularization in patients with hyperlipidemia after stratification by gender and statin therapy.

Methods and results

This retrospective cohort study included 33,204 patients with hyperlipidemia (57 ± 12 years old, 56% men, 25% black) who underwent physician-referred treadmill stress testing at the Henry Ford Health System from 1991 to 2009. Patients were stratified by gender, baseline statin therapy, and estimated metabolic equivalents from stress testing. We computed hazard ratios using Cox regression models after adjusting for demographics, cardiac risk factors, comorbidities, pertinent medications, interaction terms, and indication for stress testing.

Results

There were 4,851 deaths, 1,962 MIs, and 2,686 revascularizations over a median follow-up of 10.3 years. In men and women not on statin therapy and men and women on statin therapy, each 1-metabolic equivalent increment in CRF was associated with hazard ratios of 0.86 (95% CI 0.85-0.88), 0.83 (95% CI 0.81-0.85), 0.85 (95% CI 0.83-0.87), and 0.84 (95% CI 0.81-0.87) for mortality; 0.93 (95% CI 0.90-0.96), 0.87 (95% CI 0.83-0.91), 0.89 (95% CI 0.86-0.92), and 0.90 (95% CI 0.86-0.95) for MI; and 0.91 (95% CI 0.88-0.93), 0.87 (95% CI 0.83-0.91), 0.89 (95% CI 0.87-0.92), and 0.90 (95% CI 0.86-0.94) for revascularization, respectively. No significant interactions were observed between CRF and statin therapy (P > .23).

Conclusion

Higher CRF attenuated risk for mortality, MI, and revascularization independent of gender and statin therapy in patients with hyperlipidemia. These results reinforce the prognostic value of CRF and support greater promotion of CRF in this patient population.

Section snippets

Study design

This study is based on data from the Henry Ford ExercIse Testing Project (The FIT Project), a retrospective cohort study aimed at investigating the long-term implications of exercise capacity on cardiovascular outcomes and total mortality.47

The FIT Project is unique in its combined use of (1) directly measured exercise data, (2) retrospective collection of medical history and medication treatment data taken at the time of the stress test, (3) retrospective supplementation of supporting clinical

Baseline characteristics

Table I shows baseline characteristics and stress test results for the study population (n = 33,204), which included 14,774 (44%) women and 8,260 (25%) blacks. Online Appendix Supplementary Table I shows the lipid profile for the study population. Online Appendix Supplementary Table II shows the baseline characteristics by MET categories. Mean age of the study population was 57 ± 12 years. At baseline, 14,344 (43%) patients with hyperlipidemia were on statin therapy, of which 8,220 (57%) were

Discussion

Higher CRF was associated with markedly lower risk for mortality, MI, and subsequent revascularization in this multiethnic cohort of men and women with hyperlipidemia seen in routine clinical practice. The prognostic value of CRF was not diminished by baseline statin therapy, suggesting continued importance of CRF in all patients with hyperlipidemia.

Conclusion

Higher CRF was associated with lower risk for mortality, MIs, and subsequent revascularizations irrespective of gender and statin therapy in this cohort of patients with hyperlipidemia seen in routine clinical practice. The prognostic value of CRF was not diminished with statin therapy, suggesting that fitness remains an important consideration in all patients with hyperlipidemia, including those on statin therapy.

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      However, without an objective marker of effort, the attainment of true maximum is uncertain.31 In the ACLS, VA, and HFH cohorts, CRF was estimated from the attained speed, grade and duration at the highest stage of a treadmill exercise test.10–13,19,21–24,32–37 The prediction equations (separate equations for walking speeds, running speeds, and cycle workrates) used for this estimate were developed using steady-state, submaximal exercise levels.38

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    None of the authors have any relevant relations to industry to disclose. The present study was conducted in accordance with the Declaration of Helsinki and was approved by the Henry Ford Health System Institutional Review Board. An oral presentation of this study was presented at the American College of Cardiology Scientific Sessions in Washington, DC, on March 30, 2014. Poster presentations of this study were presented at Cardiovascular Disease Prevention International Symposium in Miami, FL, on February 6, 2014, and at the Johns Hopkins Heart and Vascular Institute's Cardiovascular Research Retreat in Baltimore, MD, on May 30, 2014.

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