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Cardiorespiratory fitness and incident heart failure: The Henry Ford ExercIse Testing (FIT) Project
Daniel F Kupsky1, Amjad M Ahmed2, Sherif Sakr2
1Heart and Vascular Institute, Henry Ford Hospital System, Detroit, MI.
Insights
Higher cardiorespiratory fitness (CRF) significantly lowers heart failure (HF) risk. Achieving 12 or more metabolic equivalents (METs) reduced HF incidence by 81%, highlighting fitness as a key factor in cardiovascular health.
Area of Science:
- Cardiology
- Preventive Medicine
- Exercise Physiology
Background:
- Cardiorespiratory fitness (CRF) is a recognized indicator of cardiovascular health.
- Limited research exists on the association between CRF and heart failure (HF) progression.
- This study investigates the relationship between CRF and the risk of developing incident HF.
Purpose of the Study:
- To determine the association between cardiorespiratory fitness and incident heart failure.
- To quantify the risk reduction of heart failure associated with different levels of CRF.
Main Methods:
- Analysis of 66,329 patients without HF who underwent exercise treadmill stress testing.
- Incident HF identified via ICD-9 codes from electronic health records and claims data.
- Cox proportional hazards models used to assess the relationship between CRF and HF incidence.
Main Results:
- A total of 4,652 patients developed HF during a median follow-up of 6.8 years.
- Patients with incident HF were older and had a higher prevalence of coronary artery disease.
- Achieving ≥12 METs was associated with an 81% lower risk of HF compared to <6 METs (HR 0.19).
- Each 1 MET increase in CRF was linked to a 16% reduced risk of HF (HR 0.84).
Conclusions:
- Elevated cardiorespiratory fitness is independently associated with a reduced incidence of heart failure.
- Higher levels of fitness may serve as a protective factor against heart failure development, irrespective of other risk factors.
Background:
Prior studies have demonstrated cardiorespiratory fitness (CRF) to be a strong marker of cardiovascular health. However, there are limited data investigating the association between CRF and risk of progression to heart failure (HF). The purpose of this study was to determine the relationship between CRF and incident HF.
Methods:
We included 66,329 patients (53.8% men, mean age 55 years) free of HF who underwent exercise treadmill stress testing at Henry Ford Health Systems between 1991 and 2009. Incident HF was determined using International Classification of Diseases, Ninth Revision codes from electronic medical records or administrative claim files. Cox proportional hazards models were performed to determine the association between CRF and incident HF.
Results:
A total of 4,652 patients developed HF after a median follow-up duration of 6.8 (±3) years. Patients with incident HF were older (63 vs 54 years, P<.001) and had higher prevalence of known coronary artery disease (42.3% vs 11%, P<.001). Peak metabolic equivalents (METs) of task were 6.3 (±2.9) and 9.1 (±3) in the HF and non-HF groups, respectively. After adjustment for potential confounders, patients able to achieve ≥12 METs had an 81% lower risk of incident HF compared with those achieving <6 METs (hazard ratio 0.19 [95% CI 0.14-0.29], P for trend < .001). Each 1 MET achieved was associated with a 16% lower risk (hazard ratio 0.84 [95% CI 0.82-0.86], P<.001) of incident HF.
Conclusions:
Our analysis demonstrates that higher level of fitness is associated with a lower incidence of HF independent of HF risk factors.
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