Exercise Test Predicts Both Noncardiovascular and Cardiovascular Death in a Primary Prevention Population

Area of Science:

• Cardiology
• Preventive Medicine
• Exercise Physiology

Background:

• Noncardiovascular (non-CV) deaths are prevalent in individuals referred for exercise testing.
• Understanding predictors of non-CV mortality is crucial for comprehensive risk assessment.

Purpose of the Study:

• To determine the prevalence of non-CV deaths in an exercise test referral population.
• To identify specific causes of non-CV mortality.
• To evaluate whether exercise test parameters predict non-CV deaths, similar to cardiovascular (CV) deaths.

Main Methods:

• Retrospective review of non-imaging exercise tests from 13,382 patients (age 30-79).
• Exclusion of patients with baseline CV disease; mortality data obtained from medical records and death index.
• Analysis of exercise test abnormalities including functional aerobic capacity, heart rate recovery, chronotropic index, and exercise electrocardiogram (ECG), and a composite score (EX_SCORE).
• Cox regression analysis adjusted for multiple risk factors.

Main Results:

• During follow-up (12.7±5.0 years), 849 deaths occurred (6.3%), with 80.9% being non-CV.
• Low functional aerobic capacity (HR 1.42), abnormal heart rate recovery (HR 1.36), and low chronotropic index (HR 1.49) significantly predicted non-CV death.
• Abnormal exercise ECG did not predict non-CV death.
• Most exercise test abnormalities were more strongly associated with CV death than non-CV death.

Conclusions:

• Non-CV deaths were predominant in this primary prevention cohort.
• Exercise test parameters, beyond predicting CV events, also serve as significant predictors of non-CV mortality.