全球动脉粥样硬化性心血管疾病风险评分与心肺功能适应性在预测全因死亡率和心肌梗死中的相互作用：亨利福特运动测试项目（FIT 项目）。
The Interplay of the Global Atherosclerotic Cardiovascular Disease Risk Scoring and Cardiorespiratory Fitness for the Prediction of All-Cause Mortality and Myocardial Infarction: The Henry Ford ExercIse Testing Project (The FIT Project).
机构信息
Department of Internal Medicine, The University of Kansas School of Medicine, Wichita, Kansas; Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland.
Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan; Wake Forest University School of Medicine, Winston Salem, North Carolina.
出版信息
Am J Cardiol. 2019 Aug 15;124(4):511-517. doi: 10.1016/j.amjcard.2019.05.033. Epub 2019 May 28.
Cardiorespiratory fitness (CRF) is inversely associated with atherosclerotic cardiovascular disease (ASCVD) risk. It is unclear whether the prognostic value of CRF differs by baseline estimated ASCVD risk. We studied a retrospective cohort of patients without known heart failure or myocardial infarction (MI) who underwent treadmill stress testing. CRF was measured by metabolic equivalents of task (METs) and ASCVD risk was calculated using the Pooled Cohorts Equations. Multivariable-adjusted Cox regressions analyses examined the association between METs and incident all-cause mortality and MI outcomes stratified by baseline ASCVD risk. The C-index evaluated risk discrimination while net reclassification improvement evaluated reclassification with CRF added to the ASCVD risk score. Our study population consisted of 57,999 patients of mean age 53 (13) years, 49% women, 64% white, 29% black. Over a median follow-up 11 years (interquartile range 8 to 14 years) there were 6,670 (11%) deaths, while there were 1,757 (3.0%) MIs over a median follow-up of 6 years (interquartile range 3 to 8 years). Among patients with ASCVD risk ≥20%, those with METs ≥12 had a 77% lower risk of all-cause mortality (Hazard ratio 0.23 95% confidence interval = 0.20, 0.27) and 67% lower risk of MI (Hazard ratio 0.33 95% confidence interval = 0.24, 0.46) compared to METs <6. Similar results were obtained for those with ASCVD risk <5%. Addition of METs to ASCVD risk score improved the C-statistic from 0.778 to 0.798 for all-cause mortality and 0.726 to 0.733 for MI (both p <0.001). Addition of METs to ASCVD risk score significantly reclassified risk of all-cause mortality (p <0.001) but not MI (p = 0.052). In conclusion, CRF is inversely associated with risk of all-cause mortality and MI at all levels of ASCVD risk, and provides incremental risk discrimination and reclassification beyond the ASCVD risk score.
心肺适能（CRF）与动脉粥样硬化性心血管疾病（ASCVD）风险呈负相关。目前尚不清楚 CRF 的预后价值是否因基线估计的 ASCVD 风险而异。我们研究了一个回顾性队列，其中包括接受跑步机运动试验但无已知心力衰竭或心肌梗死（MI）的患者。CRF 通过代谢当量（METs）测量，ASCVD 风险使用汇总队列方程计算。多变量调整的 Cox 回归分析检查了 METs 与全因死亡率和 MI 结局之间的关联，这些结局按基线 ASCVD 风险分层。C 指数评估风险区分能力，而净重新分类改善评估将 CRF 添加到 ASCVD 风险评分后的重新分类。我们的研究人群包括 57999 名平均年龄为 53（13）岁的患者，其中 49%为女性，64%为白人，29%为黑人。在中位数为 11 年（四分位距 8 至 14 年）的中位随访期间，有 6670 例（11%）死亡，而在中位数为 6 年（四分位距 3 至 8 年）的中位随访期间，有 1757 例（3.0%）MI。在 ASCVD 风险≥20%的患者中，METs≥12 的患者全因死亡率降低 77%（风险比 0.23，95%置信区间=0.20，0.27），MI 风险降低 67%（风险比 0.33，95%置信区间=0.24，0.46）与 METs<6。在 ASCVD 风险<5%的患者中也得到了类似的结果。将 METs 添加到 ASCVD 风险评分中，可将全因死亡率的 C 统计量从 0.778 提高到 0.798（均 P<0.001），将 MI 的 C 统计量从 0.726 提高到 0.733（均 P<0.001）。将 METs 添加到 ASCVD 风险评分中可显著重新分类全因死亡率的风险（P<0.001），但不重新分类 MI（P=0.052）。总之，CRF 与 ASCVD 风险各个层次的全因死亡率和 MI 风险呈负相关，并且在 ASCVD 风险评分之外提供了增量风险区分和重新分类。
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