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首页> 外文期刊>The American Journal of Cardiology >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)
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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)

机译：全球动脉粥样硬化心血管疾病的相互作用风险评分和心肺功能性的预测，用于预测全因死亡率和心肌梗死：亨利福特锻炼测试项目（FIT项目）

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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. (C) 2019 Elsevier Inc. All rights reserved.
机译：心肺功能（CRF）与动脉粥样硬化心血管疾病（ASCVD）风险反比。目前尚不清楚CRF的预后值是否因基线估计的ASCVD风险而异。我们研究了一种没有已知的心力衰竭或心肌梗塞（MI）的患者的回顾性队列，他们接受了跑步机应力测试。 CRF是通过任务（MET）的代谢等同物测量的，并且使用汇集的群组方程计算ASCVD风险。多变量调整的COX回归分析检测了由基线ASCVD风险分层的METS和事件的终结和MI结果之间的关联。 C-索引评估了风险歧视，同时净重新分类改善评估了CRF添加到ASCVD风险评分的重新分类。我们的学习人口由57,999名平均53（13）岁患者，49％的女性，64％白色，29％黑色。在一个中间的后续11年（第8至14岁的间隔范围）死亡人数为6,670（11％）死亡，而在6年的中位随访中有1,757（3.0％）MIS（第3到8岁）。在患有AscVD风险的患者中> = 20％，含有Mets> = 12的患者患者= 12的患者患有全因死亡率的风险77％（危险比率0.23 95％置信区间= 0.20,0.27）和67％的MI风险（危险比与Mets <6相比，0.33 95％置信区间= 0.24,0.46）。获得类似的结果为ASCVD风险的人<5％。对ASCVD风险评分的BETS增加了0.778至0.798的C统计，用于MI的所有原因死亡率和0.726至0.733（P <0.001）。添加到ASCVD风险评分的内容显着重新分类了所有原因死亡率的风险（P <0.001），但不是MI（p = 0.052）。总之，CRF与ASCVD风险各级的全部原因死亡率和MI的风险反向相关，并提供超出ASCVD风险得分的增量风险歧视和重新分类。 （c）2019 Elsevier Inc.保留所有权利。

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