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Sex-Specific V̇O2peak Reference Values and Their Association with Major Adverse Cardiovascular Events in Norwegian
Alexander Svenningsen1, Siri Marte Hollekim-Strand2, Jon Arne Sandmæl3
1Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
Aims:
To present sex-specific reference data for peak oxygen uptake (V̇O2peak) in Norwegian patients with coronary artery disease (CAD) undergoing cardiac rehabilitation and examine its association with major adverse cardiovascular events (MACE).
Methods:
We retrospectively analysed treadmill cardiopulmonary exercise test (CPET) data from 1,651 CAD patients (21% women; mean (SD) age 61 (9) years) attending inpatient cardiac rehabilitation (2004-2022). Patients were categorized by index event: myocardial infarction (MI), coronary artery bypass grafting, or percutaneous coronary intervention/pharmacologically treated CAD. Age-, sex-, and diagnosis-specific V̇O2peak reference data were generated. Associations between V̇O2peak and a combined MACE endpoint (all-cause mortality, acute coronary syndrome, stroke, or heart failure) were assessed using Cox proportional hazards models including natural cubic splines for assessing non-linear patterns.
Results:
Men had higher V̇O2peak than women (mean (SD) 26.9 (6.7) vs. 23.2 (5.3) mL·kg-1·min-1; p < 0.001). V̇O2peak was on average 2.5 and 1.7 mL·kg-1·min-1 lower per decade of age in men and women, respectively. Patients with a previous MI had the highest V̇O2peak, followed by CABG and PCI/CAD (p <0.001). During 7,880 person-years, 510 patients (36%) experienced MACE. Each 1 mL·kg-1·min-1 higher V̇O2peak was associated with a 7% lower MACE risk (HR [95 % CI]; 0.93 [0.92-0.95]) in men and 5% (HR [95 % CI]; 0.95 [0.91-0.99]) in women. Patients in the highest cardiorespiratory fitness quartile had a 55% lower risk compared to the lowest quartile. Associations were consistent across CAD subcategories. Sex-specific natural cubic spline models revealed inverse, non-linear associations.
Conclusion:
This study provides novel sex- and diagnosis-specific V̇O2peak reference values for Norwegian CAD patients and confirms V̇O2peak as a strong prognostic marker, supporting its integration into routine secondary prevention and individualized care.
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