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Peak Oxygen Uptake and Incident CAD
Study Questions:
What is the association between peak oxygen uptake (VO2peak), measured by cardiopulmonary exercise testing (CPET), and fatal and nonfatal coronary artery disease (CAD) in a healthy and fit population?
Methods:
A group of 12,609 participants from four preselected municipalities who had no history of cardiovascular or lung disease, cancer, sarcoidosis, or either hypertension or the use of antihypertensive medications were invited to undergo CPET; of these, 4,527 (51% women) completed CPET and had no missing variables for the main analyses. International Classification of Diseases, 10th revision (ICD-10) codes from hospital registries were used to determine CAD endpoints including percutaneous and surgical coronary revascularization, and the Norwegian Cause of Death Registry was used to determine the date and cause of deaths. The primary study endpoint was a diagnosis of CAD, coronary revascularization, or death from CAD.
Results:
Average VO2peak was 36.0 ml/kg/min and 44.4 ml/kg/min among women and men, respectively; and 83.5% had a low 10-year risk of cardiovascular disease at baseline. Average follow-up was 8.8 years, and 147 participants reached the primary endpoint. Multi-adjusted Cox-regression showed 15% lower risk for the primary endpoint per 1 metabolic equivalent task (MET) higher VO2peak (hazard ratio [HR], 0.85; 95% confidence interval [CI], 0.77-0.93), with similar results for both sexes. The highest quartile of VO2peak had a 48% lower risk of events compared with the lowest quartile (multi-adjusted HR, 0.52; 95% CI, 0.33-0.82). Oxygen pulse (maximal oxygen consumption divided by peak heart rate) and ventilatory equivalents of oxygen and carbon dioxide (minute ventilation divided by oxygen consumption or carbon dioxide ventilation) also showed significant predictive value for the primary endpoint.
Conclusions:
VO2peak was strongly and inversely associated with CAD across the whole fitness continuum in a low-risk population. The authors concluded that increasing VO2peak may have substantial benefits in reducing the burden of CAD.
Perspective:
The majority of previous research on the association between cardiorespiratory fitness and cardiovascular disease is based on indirect assessment of fitness in clinically referred and predominantly male populations. This study used data from CPET among a population predominantly at low risk of cardiovascular disease and found that higher levels of fitness (defined by VO2peak) were associated with lower risk of morbid and mortal cardiovascular events. Rather than suggesting that there is a single threshold level of fitness associated with lower cardiovascular risk, these data support that progressively greater fitness is associated with progressively lower risk.
Clinical Topics: Cardiac Surgery, Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Invasive Cardiovascular Angiography and Intervention, Prevention, Sports and Exercise Cardiology, Atherosclerotic Disease (CAD/PAD), Cardiac Surgery and Arrhythmias, Interventions and Coronary Artery Disease, Exercise, Sports and Exercise and ECG and Stress Testing
Keywords: Carbon Dioxide, Cardiac Surgical Procedures, Coronary Artery Disease, Exercise, Exercise Test, Metabolic Equivalent, Myocardial Revascularization, Oxygen Consumption, Physical Fitness, Primary Prevention, Respiration, Risk Factors
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