Quadriceps Strength as a Predictor of Mortality in Coronary Artery Disease
Kentaro Kamiya1, Takashi Masuda2, Shinya Tanaka3
1Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan.
Insights
Stronger quadriceps isometric strength (QIS) in coronary artery disease (CAD) patients significantly lowers risks of all-cause and cardiovascular death. QIS provides valuable prognostic information beyond existing risk factors.
Area of Science:
- Cardiology
- Clinical Medicine
- Exercise Physiology
Background:
- Coronary artery disease (CAD) poses significant mortality risks.
- Prognostic markers for CAD patients are crucial for risk stratification.
- Leg strength, specifically quadriceps isometric strength (QIS), has not been fully evaluated as a prognostic indicator in CAD.
Purpose of the Study:
- To investigate the prognostic value of quadriceps isometric strength (QIS) in patients with coronary artery disease (CAD).
- To determine if QIS provides incremental prognostic information beyond established risk factors.
Main Methods:
- A cohort of 1314 patients with CAD (mean age 64.7 years, 1051 male) was studied.
- Maximal QIS was measured and expressed as a percentage of body weight.
- Patients were followed for a mean of 5.0 years for all-cause and cardiovascular (CV) death.
Main Results:
- Higher QIS was significantly associated with reduced all-cause mortality (HR 0.77, P < .001) and CV mortality (HR 0.66, P < .001).
- QIS inclusion improved risk prediction models, showing significant continuous net reclassification improvement (cNRI) and integrated discrimination improvement (IDI) for both endpoints.
- These findings held after adjusting for other known prognostic factors.
Conclusions:
- Elevated quadriceps strength is strongly linked to lower mortality risks in CAD patients.
- QIS evaluation offers significant incremental prognostic value in CAD.
- QIS is a potential tool for enhancing risk assessment in cardiovascular disease management.
Background:
The purpose of this study was to investigate the prognostic value of quadriceps isometric strength (QIS) in coronary artery disease (CAD).
Methods:
The study population consisted of 1314 patients aged >30 years (64.7 ± 10.6 years, 1051 male) with CAD who were hospitalized for acute coronary syndrome or coronary artery bypass grafting. Maximal QIS was evaluated as a marker of leg strength and expressed relative to body weight (% body weight). The primary and secondary endpoints were all-cause death and cardiovascular (CV) death, respectively.
Results:
During a mean follow-up of 5.0 ± 3.5 years, corresponding to 6537 person-years, there were 118 all-cause deaths and 63 CV deaths. A higher QIS remained associated with decreased all-cause mortality and CV mortality risks (hazard ratio for increasing 10% body weight of QIS 0.77, 95% confidence interval 0.67-0.89, P < .001 for all-cause death; hazard ratio 0.66, 95% confidence interval 0.54-0.82, P < .001 for CV death) after adjustment for other prognostic factors. The inclusion of QIS significantly increased both continuous net reclassification improvement (cNRI) and integrated discrimination improvement (IDI) for all-cause death (cNRI: 0.25, P = .009; IDI: 0.007, P = .030) and CV death (cNRI: 0.34, P = .008; IDI: 0.013, P = .008).
Conclusions:
A high level of quadriceps strength was strongly associated with a lower risk of both all-cause and CV mortality in patients with CAD. Evaluation of QIS offered incremental prognostic information beyond pre-existing risk factors.
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