Peak aerobic capacity predicts prognosis in patients with coronary heart disease

• Published in: The American heart journal Vol. 156; no. 2; pp. 292 - 300
• Main Authors: Keteyian, Steven J., PhD, Brawner, Clinton A., MS, Savage, Patrick D., MS, Ehrman, Jonathan K., PhD, Schairer, John, DO, Divine, George, PhD, Aldred, Heather, PhD, Ophaug, Kristin, BS, Ades, Philip A., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.08.2008; Elsevier; Elsevier Limited
• Subjects: Biological and medical sciences; Body Mass Index; Cardiology. Vascular system; Cardiovascular; Cardiovascular disease; Cause of Death; Coronary Disease - diagnosis; Coronary Disease - metabolism; Coronary Disease - mortality; Coronary heart disease; Drug therapy; Exercise; Exercise Test; Exercise Tolerance; Female; Heart; Heart attacks; Humans; Kaplan-Meier Estimate; Male; Medical sciences; Middle Aged; Mortality; Multivariate Analysis; Observation; Oxygen Consumption; Prognosis; Proportional Hazards Models; Risk; Detroit Michigan; United States > US; Human; Prognosis; Capacity; Prediction; Cardiovascular disease; Peak; Circulatory system; Cardiology; Coronary heart disease
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2008.03.017

Background It is unknown if contemporary preventive treatments such as statins or primary percutaneous coronary intervention in patients with coronary heart disease (CHD) have rendered obsolete the use of measured exercise capacity for assessment of future risk and prognosis. Using a sample of patients from 2 clinical sites, most of whom were taking β-blockade, antiplatelet, and statin therapy, we hypothesized that peak oxygen consumption (V o2 ) would remain a strong and independent predictor of all-cause and cardiovascular-specific mortality in men and women with CHD. Methods We studied 2,812 patients with CHD between 1996 and 2004. All-cause and cardiovascular disease–specific mortality served as end points. Results In all men and women and in a subgroup of patients following evidence-based care, peak V o2 remained a strong predictor of all-cause death, with every 1 mL·kg−1 ·min−1 increase in peak V o2 associated with an approximate 15% decrease in risk of death. Among men, a peak V o2 (mL·kg−1 ·min−1 ) below ∼15 was associated with the highest risk, whereas a peak V o2 above ∼19 was associated with a low rate and risk for annual all-cause mortality. Among women, a peak V o2 below ∼12 was associated with the highest risk, whereas a peak V o2 above ∼16.5 was associated with the lowest rate and risk for annual all-cause mortality. Conclusions In men and women with CHD, peak V o2 remains an independent predictor of all-cause and cardiovascular-specific mortality.